MEDICARE: MRS. KIMBERLY ANN MOLER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2017003429	MO

General Provider Information

NPI Number	:	1184162067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN MOLER DPT

Provider Business Mailing Address
First Line	:	4887 MEXICO RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-2577
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4887 MEXICO RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-2577
Country	:	US
Telephone Number	:	636-928-1036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2017
Last Update Date	:	02/10/2017

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