MEDICARE: TRACY MOON

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	225200000X	Physical Therapy Assistant	PTA12562	FL

General Provider Information

NPI Number	:	1477487858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY MOON

Provider Business Mailing Address
First Line	:	5195 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5195 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8171
Country	:	US
Telephone Number	:	561-638-2791
Fax Number	:

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

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “ TRACY MOON ” Practice Location

Language	Start Address	Practice Location

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