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NPI Code Detail

MEDICARE: MS. JODY L MOLDENHAUER MPT

MEDICARE: MS. JODY L MOLDENHAUER MPT
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
1225100000XPhysical Therapist1368ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12271970OTHERNDAMERICA'S PPO ID
21368OTHERNDPT LICENSE NUMBER

General Provider Information

NPI Number : 1780658161
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JODY L MOLDENHAUER MPT
Provider Business Mailing Address
First Line : 325 N 31ST ST
Second Line : APT 2
City : BISMARCK
State : ND
Zip : 58501-5188
Country : US
Telephone Number : 701-391-5584
Fax Number :
Provider Business Practice Location Address
First Line : 1033 BASIN AVE
Second Line : HEALTHWAYS
City : BISMARCK
State : ND
Zip : 58504-6649
Country : US
Telephone Number : 701-223-6613
Fax Number : 701-221-9114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 07/09/2007

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