MEDICARE: KAJJA MOON HUBER

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	PTL.0016717	CO
2	225100000X	Physical Therapist	PT029468	PA

General Provider Information

NPI Number	:	1124665492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAJJA MOON HUBER

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-541-1974
Fax Number	:

Provider Business Practice Location Address
First Line	:	4870 MCKNIGHT RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-3442
Country	:	US
Telephone Number	:	412-847-8321
Fax Number	:

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

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	07/30/2021

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Directions to “ KAJJA MOON HUBER ” Practice Location

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