MEDICARE: TEASHA MOODY

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	8236	TN

General Provider Information

NPI Number	:	1902187214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEASHA MOODY

Provider Business Mailing Address
First Line	:	4109 HIGHWAY 98 W
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-9132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4131 ANDREW JACKSON PKWY
Second Line	:	VILLA 402
City	:	HERMITAGE
State	:	TN
Zip	:	37076-2270
Country	:	US
Telephone Number	:	615-316-5522
Fax Number	:

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

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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Directions to “ TEASHA MOODY ” Practice Location

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