1013321124 NPI number — DR. VICTORIA ANN MOERCHEN PT, PHD

Table of content: DR. VICTORIA ANN MOERCHEN PT, PHD (NPI 1013321124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013321124 NPI number — DR. VICTORIA ANN MOERCHEN PT, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOERCHEN
Provider First Name:
VICTORIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013321124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413
Provider Second Line Business Mailing Address:
UWM, PAVILION, PT SUITE, RM 366
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53201-0413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-229-2449
Provider Business Mailing Address Fax Number:
414-229-3366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3409 N DOWNER AVENUE
Provider Second Line Business Practice Location Address:
UWM, PAVILION, PT SUITE, RM 366
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53211-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-229-2449
Provider Business Practice Location Address Fax Number:
414-229-3366
Provider Enumeration Date:
06/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  4394-24 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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