Active NPI
Jeffrey Moon, DPT
- Physical Therapist
- Philadelphia, PA
National Provider Identifier
1417406786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT025483
- Practice address
- 520 S 19TH St
Philadelphia, PA 19146-1449 - Phone
- (215) 731-1449
- NPI assigned
- Sep 28, 2016
- Last updated
- Feb 16, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT025483 | PA | Primary |
Addresses
Primary practice location
520 S 19TH St
Philadelphia, PA 19146-1449
Mailing address
520 S 19TH St
Philadelphia, PA 19146-1449
Phone (215) 546-0251
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT025483 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487203200000",
"number": "1417406786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 S 19TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191461449",
"telephone_number": "215-546-0251",
"fax_number": "215-546-0253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 S 19TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191461449",
"telephone_number": "215-731-1449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "JEFFREY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-28",
"last_updated": "2017-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT025483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.