Healthcare Provider Details

I. General information

NPI: 1932012416
Provider Name (Legal Business Name): PATRICK C MOODY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CORAL MOODY

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 JACKSON HWY STE B
CHEHALIS WA
98532-8650
US

IV. Provider business mailing address

2923 JACKSON HWY STE B
CHEHALIS WA
98532-8650
US

V. Phone/Fax

Practice location:
  • Phone: 360-996-4778
  • Fax: 360-996-4783
Mailing address:
  • Phone: 360-996-4778
  • Fax: 360-996-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70173274
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: