MEDICARE: MR. DON NICHOLAS MOY PTA

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	208100000X	Physical Medicine & Rehabilitation Physician	AT 4835	CA

General Provider Information

NPI Number	:	1205916459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DON NICHOLAS MOY PTA

Provider Business Mailing Address
First Line	:	134 CHAUTAUQUA BLVD
Second Line	:	APT. 14
City	:	SANTA MONICA
State	:	CA
Zip	:	90402-1158
Country	:	US
Telephone Number	:	310-459-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 S SEPULVEDA BLVD
Second Line	:
City	:	WEST LOS ANGELES
State	:	CA
Zip	:	90025-4313
Country	:	US
Telephone Number	:	310-478-6222
Fax Number	:	310-478-6696

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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