Provider Demographics
NPI:1871856054
Name:MORAN, PEGGY MARGARET (LMT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:MARGARET
Last Name:MORAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28150 SE HIGHWAY 212
Mailing Address - Street 2:SUITE A
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-9100
Mailing Address - Country:US
Mailing Address - Phone:503-663-1442
Mailing Address - Fax:503-663-1443
Practice Address - Street 1:28150 SE HIGHWAY 212
Practice Address - Street 2:SUITE A
Practice Address - City:BORING
Practice Address - State:OR
Practice Address - Zip Code:97009-9100
Practice Address - Country:US
Practice Address - Phone:503-663-1442
Practice Address - Fax:503-663-1443
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6413225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist