Individual
HANNAH MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
604 N 16TH ST, CRAMER HALL, ROOM 215, MILWAUKEE, WI 53233-2117
(414) 288-1400
Mailing address
6941 DOUGLAS AVE, RACINE, WI 53402-9705
(630) 479-3751
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096.003198
IL
2255A2300X
Athletic Trainer
Primary
1792-39
WI
Other
Enumeration date
12/28/2012
Last updated
08/19/2016
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