Healthcare Provider Details

I. General information

NPI: 1992276232
Provider Name (Legal Business Name): PATRICK S MOON JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PRINGLE AVE UNIT B127
WALNUT CREEK CA
94596-3992
US

IV. Provider business mailing address

101 PRINGLE AVE UNIT B127
WALNUT CREEK CA
94596-3992
US

V. Phone/Fax

Practice location:
  • Phone: 808-386-4725
  • Fax:
Mailing address:
  • Phone: 808-386-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: