Provider Demographics
NPI:1043511736
Name:MOODY, DARLA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:LYNN
Last Name:MOODY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210
Mailing Address - Country:US
Mailing Address - Phone:270-597-3535
Mailing Address - Fax:
Practice Address - Street 1:135 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210
Practice Address - Country:US
Practice Address - Phone:270-597-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3739225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist