Individual provider Active NPI

Moonhee Jo

  • Physical Therapist
  • Woodbridge, VA
National Provider Identifier
1275870966
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305208067 Issued in VA
Practice address
4495 Cheshire Station PLZ
Woodbridge, VA 22193-2226
Phone
(571) 659-2540
Fax
(571) 659-2800
NPI assigned
Jan 15, 2013
Last updated
Mar 11, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305208067 VA Primary
Physical Therapist 225100000X 25068 MD

Addresses

Primary practice location

4495 Cheshire Station PLZ
Woodbridge, VA 22193-2226

Mailing address

4495 Cheshire Station PLZ
Woodbridge, VA 22193-2226
Phone (571) 659-2540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150116000494 DC Practitioner - Physical Therapist in Private Practice 2466698105
I20151215001975 VA Practitioner - Physical Therapist in Private Practice 2466698105 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4495 Cheshire Station PLZ
Woodbridge, VA 22193-2226
Phone (571) 659-2540

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25068MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Jos One Physical Therapy PC Physical Therapist PastSince Jan 1, 2013 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1275870966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4495 CHESHIRE STATION PLZ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221932226",
            "telephone_number": "571-659-2540",
            "fax_number": "571-659-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4495 CHESHIRE STATION PLZ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221932226",
            "telephone_number": "571-659-2540",
            "fax_number": "571-659-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JO",
        "first_name": "MOONHEE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-15",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305208067",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "25068",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.