=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447398771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM MOERSCHBAECHER PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 N THROOP ST
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60098-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-337-7410
-----------------------------------------------------
Fax | 815-337-7412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4502 LAKEWOOD RD
-----------------------------------------------------
City | MCHENRY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60050-3880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-337-7410
-----------------------------------------------------
Fax | 815-337-7412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------