Provider Demographics
NPI:1386051159
Name:MOE, DANETTE (DPT)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:MOE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6570
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-6570
Mailing Address - Country:US
Mailing Address - Phone:623-398-8072
Mailing Address - Fax:623-398-8235
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:SUITE B-408
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-795-8441
Practice Address - Fax:602-795-8447
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist