Active NPI
Gwendolyn A Moe, PHYSICAL THERAPIST
- Physical Therapist
- Jefferson City, MO
National Provider Identifier
1750582474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 118477
- Practice address
- 1432 Southwest Blvd
Jefferson City, MO 65109-2444 - Phone
- (573) 632-5440
- Fax
- (573) 632-5990
- NPI assigned
- May 30, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 118477 | MO | Primary |
Addresses
Primary practice location
1432 Southwest Blvd
Jefferson City, MO 65109-2444
Mailing address
5505 Prairie Creek Dr
Columbia, MO 65203
Phone (573) 289-2229
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 |
|---|---|---|---|
| 118477 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750582474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5505 PRAIRIE CREEK DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "65203",
"telephone_number": "573-289-2229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1432 SOUTHWEST BLVD",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651092444",
"telephone_number": "573-632-5440",
"fax_number": "573-632-5990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOE",
"first_name": "GWENDOLYN",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "118477",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.