Healthcare Provider Details

I. General information

NPI: 1700435732
Provider Name (Legal Business Name): RENEE MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE JOHNSON

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LOVELL AVE W
SAINT PAUL MN
55113-4459
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 651-484-3378
  • Fax:
Mailing address:
  • Phone: 920-830-5900
  • Fax: 920-830-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16261
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11666
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: