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General NPI Number Information
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NPI Number | 1245725316
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Entity Type | Individual
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Provider Name | ASHLEY MOEDER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 611 PEACE ST STE C
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City | LA CROSSE
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State | KS
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Zip | 67548-9587
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Country | US
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Telephone | 785-514-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 602 E 5TH ST
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City | LA CROSSE
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State | KS
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Zip | 67548-9525
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Country | US
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Telephone | 620-923-6001
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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 | 2251E1200X
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Taxonomy Name | Ergonomics Physical Therapist
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License Number | 11-04980
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 11-04980
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 11-04980
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-04980
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License Number State | KS
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