Provider Demographics
NPI:1497062004
Name:MORING, GREGORY (LMP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MORING
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S OAK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-1589
Mailing Address - Country:US
Mailing Address - Phone:206-940-5365
Mailing Address - Fax:
Practice Address - Street 1:160 S OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1589
Practice Address - Country:US
Practice Address - Phone:206-940-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60159639172M00000X
OR18188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR18188OtherSTATE OF OREGON BOARD OF MASSAGE THERAPISTS