Provider Demographics
NPI:1235180977
Name:MOSELEY, MEGAN MARIE (PT, LMT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:PT, LMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 NW IRVING ST
Mailing Address - Street 2:APT 709
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2260
Mailing Address - Country:US
Mailing Address - Phone:541-912-0594
Mailing Address - Fax:541-343-6206
Practice Address - Street 1:1030 NW 12TH AVE
Practice Address - Street 2:STE 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2838
Practice Address - Country:US
Practice Address - Phone:503-701-4390
Practice Address - Fax:503-974-2612
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2017-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR2177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist