Individual
DERICK WILLIAMS MOODY
Active
Individual
DERICK WILLIAMS MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMP
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
P160045527
WA
225700000X
Massage Therapist
Primary
MA60298052
WA
Other
Enumeration date
02/27/2013
Last updated
07/10/2013
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