Provider Demographics
NPI:1831128651
Name:BEATA MORENO, PT PC
Entity Type:Organization
Organization Name:BEATA MORENO, PT PC
Other - Org Name:BEATA MORENO, PT PC, HOLISTIC PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEATA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-246-8282
Mailing Address - Street 1:4031 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5243
Mailing Address - Country:US
Mailing Address - Phone:503-246-8282
Mailing Address - Fax:503-231-6605
Practice Address - Street 1:4031 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5243
Practice Address - Country:US
Practice Address - Phone:503-246-8282
Practice Address - Fax:503-231-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116217OtherMEDICARE GROUP NUMBER
OR116217OtherMEDICARE GROUP NUMBER