Caroline Paula Moody, MASSAGE THERAPIST

Individual provider Active NPI Mechanotherapist · Lake Butler, FL

NPI 1043592843 · NPPES record last updated Sep 16, 2011

Key facts

NPI
1043592843
Entity type
Individual (NPI type 1)
Primary specialty
Mechanotherapist 172M00000X
License
MA58462 (FL)
Practice address
5800 SW 53Rd St
Lake Butler, FL 32054-5316
Phone
(386) 496-2023
Fax
(386) 496-2023
NPI assigned
Sep 16, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
MA58462FLMDMechanotherapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mechanotherapist 172M00000X MA58462 FL Yes

Addresses

Primary practice location

5800 SW 53Rd St
Lake Butler, FL 32054-5316

Mailing address

5800 SW 53Rd St
Lake Butler, FL 32054-5316
Phone (386) 496-2023

Other providers in Lake Butler, FL

All providers in Lake Butler, FL · Mechanotherapist in Florida

Sources for this page

Verify at the official NPI Registry.