Provider Demographics
NPI:1043592843
Name:MOODY, CAROLINE PAULA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:PAULA
Last Name:MOODY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-5316
Mailing Address - Country:US
Mailing Address - Phone:386-496-2023
Mailing Address - Fax:386-496-2023
Practice Address - Street 1:5800 SW 53RD ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-5316
Practice Address - Country:US
Practice Address - Phone:386-496-2023
Practice Address - Fax:386-496-2023
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA58462172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist