Active NPI
Melissa Moenkedick, DPT
- Physical Therapist
- Alexandria, MN
National Provider Identifier
1194378620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11204
- Practice address
- 111 17TH Ave E
Alexandria, MN 56308-5273 - Phone
- (320) 762-6079
- NPI assigned
- Jul 23, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11-06073 | KS | |
| Physical Therapist | 225100000X | PT-5556 | ID | |
| Physical Therapist | 225100000X | 11204 | MN | Primary |
Addresses
Primary practice location
111 17TH Ave E
Alexandria, MN 56308-5273
Mailing address
111 17TH Ave E
Alexandria, MN 56308-5273
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-5556 | ID | MD | Physical Therapist |
| 11-06073 | KS | MD | Physical Therapist |
| 11204 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700438400000",
"number": "1194378620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 17TH AVE E",
"city": "ALEXANDRIA",
"state": "MN",
"postal_code": "563085273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 17TH AVE E",
"city": "ALEXANDRIA",
"state": "MN",
"postal_code": "563085273",
"telephone_number": "320-762-6079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOENKEDICK",
"first_name": "MELISSA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-23",
"last_updated": "2023-11-20",
"certification_date": "2023-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "11-06073",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-5556",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alexandria, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.