Provider Demographics
NPI:1154636058
Name:MOODY, ELSBETH D (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ELSBETH
Middle Name:D
Last Name:MOODY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:ELSBETH
Other - Middle Name:D
Other - Last Name:BELLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1033 REGENTS BLVD. STE 204
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-564-1288
Mailing Address - Fax:253-564-1752
Practice Address - Street 1:1033 REGENTS BLVD. STE 204
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-564-1288
Practice Address - Fax:253-564-1752
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60129821225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist