MEDICARE: ANDREW MOY 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	174400000X	Specialist	070020403	IL
2	225100000X	Physical Therapist	070020403	IL

General Provider Information

NPI Number	:	1669891800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW MOY PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 S HALSTED ST
Second Line	:	SUITE 116
City	:	CHICAGO
State	:	IL
Zip	:	60608-5805
Country	:	US
Telephone Number	:	312-842-1205
Fax Number	:	312-842-1356

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	09/03/2015

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Directions to “ ANDREW MOY PT” Practice Location

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