Active NPI
Adam Joseph Moody, PTA
- Physical Therapy Clinic/Center
- Kankakee, IL
National Provider Identifier
1194237677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 160006509
- Practice address
- 7 Durell Dr
Kankakee, IL 60901-6001 - Phone
- (000) 000-0000
- NPI assigned
- Oct 24, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 160006509 | IL | Primary |
Addresses
Primary practice location
7 Durell Dr
Kankakee, IL 60901-6001
Mailing address
7 Durell Dr
Kankakee, IL 60901-6001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160006509 | IL | MD | Physical Therapy Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508803200000",
"number": "1194237677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 DURELL DR",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609016001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 DURELL DR",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609016001",
"telephone_number": "000-000-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOODY",
"first_name": "ADAM",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-24",
"last_updated": "2017-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "IL",
"license": "160006509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.