Provider Demographics
NPI:1558626366
Name:MORASCH, MARY M (LMT, LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:MORASCH
Suffix:
Gender:F
Credentials:LMT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10809 NE SKIDMORE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2679
Mailing Address - Country:US
Mailing Address - Phone:503-810-5394
Mailing Address - Fax:
Practice Address - Street 1:10809 NE SKIDMORE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2679
Practice Address - Country:US
Practice Address - Phone:503-810-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16532172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist