Derick Williams Moody, LMP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60298052 Issued in WA

Practice address

4060 Wheaton Way
Ste. C
Bremerton, WA 98310-3500

Phone

(360) 479-8477

Fax

(360) 479-8417

NPI assigned

Feb 27, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MVP Physical Therapy, Inc.

  • Physical Therapist
  • Tacoma, WA
  • NPI 1205124302

  Massage Therapist

  NPD (past)
• MVP Physical Therapy, Inc.

  • Physical Therapist
  • Port Orchard, WA
  • NPI 1376501643
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373414400000",
    "number": "1558601674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 ORCHARD ST W",
            "address_2": "STE. 100",
            "city": "FIRCREST",
            "state": "WA",
            "postal_code": "984666606",
            "telephone_number": "253-564-1560",
            "fax_number": "253-564-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 WHEATON WAY",
            "address_2": "STE. C",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983103500",
            "telephone_number": "360-479-8477",
            "fax_number": "360-479-8417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "DERICK",
        "middle_name": "WILLIAMS",
        "credential": "LMP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-27",
        "last_updated": "2013-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160045527",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60298052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walter Anton Moller, LMP
• Moment of Peace Therapy PLLC
• Jessiebel C Montiero, RBT
• Sofia Rebekah Montoya, LMP, RYT
• Freda K Monu O' Donoghue, LISW
• Emma Moody
• Stefanie Moon, RN
• Ada C Moore-de la Cruz
• Suzanne Moore-Ullrich, MA, LMHC
• Donna Elizabeth Moore, MD

• Massage Therapist in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.