Provider Demographics
NPI:1275870966
Name:JO, MOONHEE
Entity Type:Individual
Prefix:
First Name:MOONHEE
Middle Name:
Last Name:JO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 CHESHIRE STATION PLZ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2226
Mailing Address - Country:US
Mailing Address - Phone:571-659-2540
Mailing Address - Fax:571-659-2800
Practice Address - Street 1:4495 CHESHIRE STATION PLZ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2226
Practice Address - Country:US
Practice Address - Phone:571-659-2540
Practice Address - Fax:571-659-2800
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208067225100000X
MD25068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist