Provider Demographics
NPI:1811072788
Name:LIEBERSON, MOIRA B (PT)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:B
Last Name:LIEBERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MOIRA
Other - Middle Name:B
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 NW VAUGHN ST
Mailing Address - Street 2:STE 140
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5311
Mailing Address - Country:US
Mailing Address - Phone:503-499-5200
Mailing Address - Fax:
Practice Address - Street 1:2701 NW VAUGHN ST
Practice Address - Street 2:STE 140
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5311
Practice Address - Country:US
Practice Address - Phone:503-499-5155
Practice Address - Fax:503-499-5213
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2946225100000X
WAPT00006778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist