Healthcare Provider Details

I. General information

NPI: 1013321124
Provider Name (Legal Business Name): VICTORIA ANN MOERCHEN PT, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 N DOWNER AVENUE UWM, PAVILION, PT SUITE, RM 366
MILWAUKEE WI
53211-2956
US

IV. Provider business mailing address

PO BOX 413 UWM, PAVILION, PT SUITE, RM 366
MILWAUKEE WI
53201-0413
US

V. Phone/Fax

Practice location:
  • Phone: 414-229-2449
  • Fax: 414-229-3366
Mailing address:
  • Phone: 414-229-2449
  • Fax: 414-229-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4394-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: