Healthcare Provider Details

I. General information

NPI: 1588501498
Provider Name (Legal Business Name): NATALIE MOON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 ORRIN ST SE
VIENNA VA
22180-4835
US

IV. Provider business mailing address

517 ORRIN ST SE
VIENNA VA
22180-4835
US

V. Phone/Fax

Practice location:
  • Phone: 917-582-1708
  • Fax: 917-582-1708
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: