Individual
DUSTIN JOEL MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
111 MONTICELLO AVE STE B, CHARLOTTESVILLE, VA 22902-5698
(434) 817-7848
Mailing address
504 ALBEMARLE SQ, CHARLOTTESVILLE, VA 22901-7405
(434) 817-7848
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305216399
VA
225100000X
Physical Therapist
5786
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500601383
—
OR
Enumeration date
09/30/2008
Last updated
09/05/2024
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