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General NPI Number Information
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NPI Number | 1780554865
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Entity Type | Individual
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Provider Name | KATIE MOODY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 3125 BLUE LAKE DR
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City | VESTAVIA
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State | AL
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Zip | 35243-2333
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Country | US
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Telephone | 205-969-7887
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Fax |
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Provider Business Mailing Address
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Address Line | 206 STONEHAVEN TRCE
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City | PELHAM
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State | AL
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Zip | 35124-3945
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH12530
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License Number State | AL
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