Healthcare Provider Details

I. General information

NPI: 1306794847
Provider Name (Legal Business Name): ANNIKA MOLLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 S SIGNAL BUTTE RD UNIT B106
MESA AZ
85209-2602
US

IV. Provider business mailing address

980 W JERSEY WAY
SAN TAN VALLEY AZ
85143-5060
US

V. Phone/Fax

Practice location:
  • Phone: 480-272-7797
  • Fax:
Mailing address:
  • Phone: 480-544-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-014279
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: