MEDICARE: ALLYSON DENISE MOONEY 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	225200000X	Physical Therapy Assistant	3773	CA

General Provider Information

NPI Number	:	1669877338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON DENISE MOONEY PTA

Provider Business Mailing Address
First Line	:	8823 GREENWOOD AVE
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-1244
Country	:	US
Telephone Number	:	626-422-4138
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3517
Country	:	US
Telephone Number	:	310-423-6281
Fax Number	:

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

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	10/23/2014

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Directions to “ ALLYSON DENISE MOONEY PTA” Practice Location

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