Provider Demographics
NPI:1427212646
Name:MOON, JAE JOON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JAE JOON
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S PARKER RD STE 135
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1603
Mailing Address - Country:US
Mailing Address - Phone:303-283-0130
Mailing Address - Fax:303-283-0131
Practice Address - Street 1:2600 S PARKER RD STE 135
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1603
Practice Address - Country:US
Practice Address - Phone:303-283-0130
Practice Address - Fax:303-283-0131
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1881822930OtherNPI GROUP NUMBER
CO527268OtherMEDICARE PROVIDER NUMBER