Healthcare Provider Details

I. General information

NPI: 1477487858
Provider Name (Legal Business Name): TRACY MOON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5195 W ATLANTIC AVE
DELRAY BEACH FL
33484-8171
US

IV. Provider business mailing address

5195 W ATLANTIC AVE
DELRAY BEACH FL
33484-8171
US

V. Phone/Fax

Practice location:
  • Phone: 561-638-2791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA12562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: