Provider Demographics
NPI:1528607322
Name:MOODIE, KRISTY (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:MOODIE
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:PO BOX 229085
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-0903
Mailing Address - Country:US
Mailing Address - Phone:360-305-8362
Mailing Address - Fax:
Practice Address - Street 1:7858 HAM RD
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:WA
Practice Address - Zip Code:98240-9517
Practice Address - Country:US
Practice Address - Phone:360-305-8362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist