Individual
DUSTIN JOEL MOON
Active
Individual
DUSTIN JOEL MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
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
Update your record
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