Provider Demographics
NPI:1104925759
Name:MOON, F JILLIAN (RPTCHT)
Entity type:Individual
Prefix:
First Name:F
Middle Name:JILLIAN
Last Name:MOON
Suffix:
Gender:F
Credentials:RPTCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2430
Mailing Address - Country:US
Mailing Address - Phone:805-563-5333
Mailing Address - Fax:805-563-5305
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2430
Practice Address - Country:US
Practice Address - Phone:805-563-5333
Practice Address - Fax:805-563-5305
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT54472251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT5447Medicare PIN
CAWPT5447AMedicare ID - Type UnspecifiedPPIN
CAP53417Medicare UPIN