Provider Demographics
NPI:1023183639
Name:MOODY, MELANIE J (PT)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:J
Last Name:MOODY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N HAGER AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3002
Mailing Address - Country:US
Mailing Address - Phone:847-842-0176
Mailing Address - Fax:847-842-0178
Practice Address - Street 1:125 N HAGER AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3002
Practice Address - Country:US
Practice Address - Phone:847-842-0176
Practice Address - Fax:847-842-0178
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist