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General NPI Number Information
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NPI Number | 1194378620
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Entity Type | Individual
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Provider Name | MELISSA MOENKEDICK DPT
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Gender | Female
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 111 17TH AVE E
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City | ALEXANDRIA
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State | MN
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Zip | 56308-5273
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Country | US
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Telephone | 320-762-6079
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Fax |
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Provider Business Mailing Address
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Address Line | 111 17TH AVE E
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City | ALEXANDRIA
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State | MN
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Zip | 56308-5273
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-06073
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-5556
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11204
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License Number State | MN
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