Provider Demographics
NPI:1205881471
Name:MOELLER, CASEY J (DPT)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:J
Last Name:MOELLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-0294
Mailing Address - Country:US
Mailing Address - Phone:402-826-2255
Mailing Address - Fax:402-826-2288
Practice Address - Street 1:830 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-3108
Practice Address - Country:US
Practice Address - Phone:402-826-2255
Practice Address - Fax:402-826-2288
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1924225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE36516OtherBLUE CROSS BLUE SHIELD
650013667OtherRAILROAD MEDICARE