Provider Demographics
NPI:1851100697
Name:MOODY, MAYA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 ASH DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5901
Mailing Address - Country:US
Mailing Address - Phone:406-570-6966
Mailing Address - Fax:
Practice Address - Street 1:1660 W ANTELOPE DR STE 225A
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1156
Practice Address - Country:US
Practice Address - Phone:801-702-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist