Provider Demographics
NPI:1891856423
Name:MOLER, MICHELLE A (MSPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:MOLER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:COON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4739 MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-586-2772
Mailing Address - Fax:406-586-2644
Practice Address - Street 1:2430 N 7TH AVE
Practice Address - Street 2:ALTA PT AND FITNESS UNIT 2
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-586-2772
Practice Address - Fax:406-586-2644
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist