Traci Lynne Moeller, PTA

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

160.006323 Issued in IL

Practice address

2171 W Executive Dr
Suite 500
Addison, IL 60101-5625

Phone

(630) 766-0505

NPI assigned

Feb 4, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454544000000",
    "number": "1801254834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6006 WHITEOAK DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600501711",
            "telephone_number": "608-393-7606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2171 W EXECUTIVE DR",
            "address_2": "SUITE 500",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601015625",
            "telephone_number": "630-766-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOELLER",
        "first_name": "TRACI",
        "middle_name": "LYNNE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-04",
        "last_updated": "2016-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "160.006323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aarika Miller, LCSW, CDVP
• Andrew Allan Miller, D.D.S
• Deborah Jean Miller, OTR/L
• Omid Mirkhani, DMD
• Kristin Mital, M.S. -SLP
• Anna Molavi, DMD
• Jessica Molinar
• John P Moran, M.D.
• Anthony F Morelli, D.D.S
• Latoya Morgan

• Physical Therapy Clinic/Center in Addison, IL
• Providers in Addison, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.