Healthcare Provider Details

I. General information

NPI: 1073737268
Provider Name (Legal Business Name): ERIN W MOODY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10278 CORPORATE DR
GULFPORT MS
39503-4604
US

IV. Provider business mailing address

10278 CORPORATE DR
GULFPORT MS
39503-4604
US

V. Phone/Fax

Practice location:
  • Phone: 228-265-7005
  • Fax: 228-200-5671
Mailing address:
  • Phone: 228-265-7005
  • Fax: 228-200-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3736
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: