Provider Demographics
NPI:1346763703
Name:MOODY, ANNE MARIA (DPT, PCS)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIA
Last Name:MOODY
Suffix:
Gender:F
Credentials:DPT, PCS
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIA
Other - Last Name:ZIEGLTRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PCS
Mailing Address - Street 1:6108 W MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4849
Mailing Address - Country:US
Mailing Address - Phone:360-951-2491
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist