Individual
MR. BENJAMIN T MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT, ATC
Contact information
Practice address
1230 17TH AVE, #3, SAN FRANCISCO, CA 94122-1918
(415) 627-7900
Mailing address
1230 17TH AVE, #3, SAN FRANCISCO, CA 94122-1918
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
24091
CA
2255A2300X
Athletic Trainer
029802426
CA
Other
Enumeration date
02/04/2011
Last updated
02/04/2011
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