Angela Jean Moderson, PTA
Individual provider Active NPI Physical Therapy Assistant · Weyauwega, WI
NPI 1447407341 · NPPES record last updated Aug 21, 2008
Key facts
- NPI
- 1447407341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 856-019 (WI)
- Practice address
- 717 E Alfred St
Weyauwega, WI 54983-9024 - Phone
- (920) 867-3121
- Fax
- (920) 867-3997
- NPI assigned
- Aug 21, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 856-019 | WI | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 856-019 | WI | Yes |
Addresses
Primary practice location
717 E Alfred St
Weyauwega, WI 54983-9024
Mailing address
717 E Alfred St
Weyauwega, WI 54983-9024
Phone (920) 867-3121
Other providers in Weyauwega, WI
- Iris Health Clinic LLC
- Tatiana Jansen
- Kevin Richard Johnson
- Jana Marie Kizewski
- Valerie Mahoney
- Northwest Journey - Waupaca County
- Hope Marie Oshefsky
- Deann Marie Paprocki
- Mirissa Lee Roemer
- Tammi Ann Schellin
All providers in Weyauwega, WI · Physical Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.