Healthcare Provider Details

I. General information

NPI: 1992636856
Provider Name (Legal Business Name): SHIRLY MOONEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 3RD AVE E
BIG STONE GAP VA
24219-3114
US

IV. Provider business mailing address

PO BOX 240
WISE VA
24293-0240
US

V. Phone/Fax

Practice location:
  • Phone: 276-523-0599
  • Fax: 276-523-6480
Mailing address:
  • Phone: 276-523-0599
  • Fax: 276-523-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305003848
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: