Provider Demographics
NPI:1538577796
Name:MOELLER, ALYSSA C (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:C
Last Name:MOELLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:C
Other - Last Name:MERTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1715 E 47TH STREET PL
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2697
Mailing Address - Country:US
Mailing Address - Phone:308-520-6032
Mailing Address - Fax:
Practice Address - Street 1:1715 E 47TH STREET PL
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2697
Practice Address - Country:US
Practice Address - Phone:308-520-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist