Provider Demographics
NPI:1821386624
Name:MOON, CELINA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CELINA
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RAYCREST DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NH
Mailing Address - Zip Code:03593-5212
Mailing Address - Country:US
Mailing Address - Phone:401-497-1470
Mailing Address - Fax:
Practice Address - Street 1:71 HOBBS ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-8109
Practice Address - Country:US
Practice Address - Phone:603-447-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist