Healthcare Provider Details

I. General information

NPI: 1245606623
Provider Name (Legal Business Name): ALICIA ROESGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA MOELLER DPT

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 CEDAR ST
MUSCATINE IA
52761-2612
US

IV. Provider business mailing address

2002 CEDAR ST
MUSCATINE IA
52761-2612
US

V. Phone/Fax

Practice location:
  • Phone: 563-264-2023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number075402
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: