MEDICARE: MATTHEW MOONEY DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	24785	MA

General Provider Information

NPI Number	:	1043894728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW MOONEY DPT

Provider Business Mailing Address
First Line	:	825 WASHINGTON ST STE 280
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-3449
Country	:	US
Telephone Number	:	781-769-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 WASHINGTON ST STE 280
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-3449
Country	:	US
Telephone Number	:	781-769-2040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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