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NPI Code Detail

MEDICARE: MRS. TARA K. MOON MS, PT

MEDICARE: MRS. TARA K. MOON MS, PT
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
12251P0200XPediatric Physical Therapist11-03207KS

General Provider Information

NPI Number : 1851391171
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA K. MOON MS, PT
Provider Business Mailing Address
First Line : 14068 W 147TH PL
Second Line :
City : OLATHE
State : KS
Zip : 66062-8869
Country : US
Telephone Number : 913-593-5939
Fax Number :
Provider Business Practice Location Address
First Line : 3715 W 133RD ST
Second Line :
City : LEAWOOD
State : KS
Zip : 66209-3347
Country : US
Telephone Number : 913-593-5939
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 11/03/2016

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