Mark Jason Moan

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Practice address

1975 Glenn Mitchell Dr Ste 101
Virginia Beach, VA 23456-0167

Phone

(757) 507-0015

NPI assigned

Mar 8, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1646697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1730836818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 GLENN MITCHELL DR STE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234560167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 GLENN MITCHELL DR STE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234560167",
            "telephone_number": "757-507-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOAN",
        "first_name": "MARK",
        "middle_name": "JASON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-08",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• ML Bawcom & Associates (Bawcom Chiropractic Clinic)
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• MMS Norfolk, Inc. (Medical Equipment Distributors of Virginia)
• Ashley Dean Moan, NP
• Massoum Moayery, M.D.
• Mobenn LLC
• Mobile Mental Health LLC
• Chassidy Mobley, BSN-RN
• Brooke Alexis Modderman

• Orthopedic Physical Therapist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Orthopedic Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.