Provider Demographics
NPI:1336575018
Name:MOELLER, VANESSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MOELLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:COIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 112TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-4828
Mailing Address - Country:US
Mailing Address - Phone:425-490-7430
Mailing Address - Fax:425-645-2954
Practice Address - Street 1:13352 N 83RD AVE
Practice Address - Street 2:STE. A-101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4158
Practice Address - Country:US
Practice Address - Phone:623-979-8900
Practice Address - Fax:623-979-1809
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013004036225100000X
AZ10496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist