Provider Demographics
NPI:1285705327
Name:MOODY, EMILY J (PT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:MOODY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:HARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10905 COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3715
Mailing Address - Country:US
Mailing Address - Phone:402-657-3299
Mailing Address - Fax:
Practice Address - Street 1:10905 COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3715
Practice Address - Country:US
Practice Address - Phone:402-657-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist