Individual
SUZANNA MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MMP
Contact information
Practice address
704 SOUTH BOIS DARC AVENUE, TYLER, TX 75701
(903) 520-8611
Mailing address
704 SOUTH BOIS DARC, TYLER, TX 75701
(903) 520-8611
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
102131
TX
Other
Enumeration date
04/22/2015
Last updated
04/22/2015
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