Provider Demographics
NPI:1578662979
Name:MOXIE BODY P C
Entity Type:Organization
Organization Name:MOXIE BODY P C
Other - Org Name:MOXIE BODY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-522-4132
Mailing Address - Street 1:407 NE 12TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2752
Mailing Address - Country:US
Mailing Address - Phone:503-522-4132
Mailing Address - Fax:503-239-6125
Practice Address - Street 1:407 NE 12TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2752
Practice Address - Country:US
Practice Address - Phone:503-522-4132
Practice Address - Fax:503-239-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3045261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy