Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 13344 | NC |
NPI | 1003190919 |
---|---|
Provider Name | Shawn R. Moody |
First Address | Durham, NC 27704-2150 |
Second Address | Durham, NC 27704-2150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2011 |
Last Update Date | 11/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13344 | NC PT LICENSE (01) | NC |