Provider Demographics
NPI:1588803456
Name:MURDOCK, KALEY M (PT)
Entity Type:Individual
Prefix:MS
First Name:KALEY
Middle Name:M
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 SW 66TH AVE APT 325
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6036
Mailing Address - Country:US
Mailing Address - Phone:541-778-4693
Mailing Address - Fax:
Practice Address - Street 1:9750 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4449
Practice Address - Country:US
Practice Address - Phone:503-256-3920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5743261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy