Provider Demographics
NPI:1245725316
Name:MOEDER, ASHLEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MOEDER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:KS
Mailing Address - Zip Code:67548-9525
Mailing Address - Country:US
Mailing Address - Phone:620-923-6001
Mailing Address - Fax:
Practice Address - Street 1:611 PEACE ST STE C
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:KS
Practice Address - Zip Code:67548-9587
Practice Address - Country:US
Practice Address - Phone:785-514-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-049802251E1200X, 2251G0304X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic