MEDICARE: DR. VICTORIA ANN MOERCHEN PT, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	4394-24	WI

General Provider Information

NPI Number	:	1013321124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA ANN MOERCHEN PT, PHD

Provider Business Mailing Address
First Line	:	PO BOX 413
Second Line	:	UWM, PAVILION, PT SUITE, RM 366
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-0413
Country	:	US
Telephone Number	:	414-229-2449
Fax Number	:	414-229-3366

Provider Business Practice Location Address
First Line	:	3409 N DOWNER AVENUE
Second Line	:	UWM, PAVILION, PT SUITE, RM 366
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-2956
Country	:	US
Telephone Number	:	414-229-2449
Fax Number	:	414-229-3366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	06/17/2014

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