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General NPI Number Information
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NPI Number | 1467756858
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Entity Type | Individual
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Provider Name | VIRGINIA GRACE MOELLER DPT
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Gender | Female
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 12/24/2015
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Provider Practice Location Address
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Address Line | 8919 PARK RD
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City | CHARLOTTE
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State | NC
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Zip | 28210-9600
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Country | US
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Telephone | 704-421-8170
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Fax |
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Provider Business Mailing Address
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Address Line | 3612 WHEATON PL S
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City | CHARLOTTE
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State | NC
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Zip | 28211-3429
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Country | US
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Telephone | 704-421-8170
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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 | PT 26110
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License Number State | FL
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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 | 1212709
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License Number State | TX
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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 | 13824
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License Number State | NC
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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 | 6876
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License Number State | SC
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