Healthcare Provider Details

I. General information

NPI: 1952078610
Provider Name (Legal Business Name): HANNAH R MOEN DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 FRANCE AVE S
EDINA MN
55435-2104
US

IV. Provider business mailing address

762 WISCONSIN AVE N
GOLDEN VALLEY MN
55427-4267
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-1340
  • Fax:
Mailing address:
  • Phone: 612-251-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12407
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: