Individual
DERICK WILLIAMS MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
4060 WHEATON WAY, STE. C, BREMERTON, WA 98310-3500
(360) 479-8477
(360) 479-8417
Mailing address
4040 ORCHARD ST W, STE. 100, FIRCREST, WA 98466-6606
(253) 564-1560
(253) 564-4449
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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