Provider Demographics
NPI:1821216680
Name:MORELAND PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MORELAND PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-230-4833
Mailing Address - Street 1:6336 SE MILWAUKIE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5419
Mailing Address - Country:US
Mailing Address - Phone:503-230-4833
Mailing Address - Fax:503-235-4250
Practice Address - Street 1:6336 SE MILWAUKIE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5419
Practice Address - Country:US
Practice Address - Phone:503-230-4833
Practice Address - Fax:503-235-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117846Medicaid
OR117846Medicaid