MEDICARE: MAYA MOODY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1851100697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA MOODY PT, DPT

Provider Business Mailing Address
First Line	:	1426 ASH DR
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-5901
Country	:	US
Telephone Number	:	406-570-6966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 W ANTELOPE DR STE 225A
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-1156
Country	:	US
Telephone Number	:	801-702-8475
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	02/05/2025

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Directions to “ MAYA MOODY PT, DPT” Practice Location

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