Provider Demographics
NPI:1700378213
Name:PIROS, ANNIKA KRISTINA ILSE
Entity Type:Individual
Prefix:
First Name:ANNIKA
Middle Name:KRISTINA ILSE
Last Name:PIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNIKA
Other - Middle Name:KRISTINA ILSE
Other - Last Name:MOFFETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:685 36TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4741
Mailing Address - Country:US
Mailing Address - Phone:503-540-8701
Mailing Address - Fax:
Practice Address - Street 1:675 ORCHARD HEIGHTS RD NW STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3041
Practice Address - Country:US
Practice Address - Phone:503-391-5542
Practice Address - Fax:503-391-5695
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist