Active NPI
Melanie Michelle Moebes
- Pediatric Physical Therapist
- Lawrenceville, GA
National Provider Identifier
1841366341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- PT006474
- Practice address
- 545 Old Norcross Rd
Suite 100
Lawrenceville, GA 30046-3389 - Phone
- (678) 377-2833
- Fax
- (678) 377-2882
- NPI assigned
- Nov 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | PT006474 | GA | Primary |
Addresses
Primary practice location
545 Old Norcross Rd
Suite 100
Lawrenceville, GA 30046-3389
Mailing address
5590 Trion Cove
Norcross, GA 30092
Phone (770) 825-0015
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 307923 | Other | GA | WELLCARE-AAKTS |
| 00852178C | Medicaid | GA |
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 |
|---|---|---|---|
| PT006474 | GA | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285804800000",
"number": "1841366341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5590 TRION COVE",
"city": "NORCROSS",
"state": "GA",
"postal_code": "30092",
"telephone_number": "770-825-0015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 OLD NORCROSS RD",
"address_2": "SUITE 100",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300463389",
"telephone_number": "678-377-2833",
"fax_number": "678-377-2882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOEBES",
"first_name": "MELANIE",
"middle_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-27",
"last_updated": "2010-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "GA",
"license": "PT006474",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE-AAKTS",
"identifier": "307923",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00852178C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.