MEDICARE: DAREN MOAT 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
1	225100000X	Physical Therapist	2305005895	VA

General Provider Information

NPI Number	:	1043211352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAREN MOAT PT

Provider Business Mailing Address
First Line	:	24801 PINEBROOK RD STE 200
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4113
Country	:	US
Telephone Number	:	703-722-2525
Fax Number	:	703-327-6708

Provider Business Practice Location Address
First Line	:	24801 PINEBROOK RD STE 200
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4113
Country	:	US
Telephone Number	:	703-722-2525
Fax Number	:	703-327-6708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	04/13/2021

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