Provider Demographics
NPI:1609178169
Name:MOECKEL, KRISTOPHER NEAL (MPT)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:NEAL
Last Name:MOECKEL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 SHORELINE DR
Mailing Address - Street 2:#2105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4902
Mailing Address - Country:US
Mailing Address - Phone:760-927-6730
Mailing Address - Fax:
Practice Address - Street 1:10992 SAN DIEGO MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2444
Practice Address - Country:US
Practice Address - Phone:619-241-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist