MEDICARE: J MOON PHYSICAL THERAPY PC

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

General Provider Information

NPI Number	:	1154014215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J MOON PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	7945 METROPOLITAN AVE
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7945 METROPOLITAN AVE
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2938
Country	:	US
Telephone Number	:	347-421-8173
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	JISU YU
Credential	:
Telephone Number	:	347-421-8173

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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