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General NPI Number Information
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NPI Number | 1730559782
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Entity Type | Individual
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Provider Name | CODY L MOLDENHAUER DPT
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Gender | Male
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Dates
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Enumeration Date | 10/02/2015
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 2615 N DOWNER AVE
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City | MILWAUKEE
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State | WI
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Zip | 53211-4245
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Country | US
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Telephone | 414-962-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 600 OAKMONT LN STE 600C
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City | WESTMONT
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State | IL
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Zip | 60559-5548
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Country | US
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Telephone | 630-575-1980
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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 | 11813
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License Number State | TN
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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 | PTL.0013650
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License Number State | CO
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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 | 13200-24
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License Number State | WI
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