Provider Demographics
NPI:1831240571
Name:MURDOCK, MARGARET L (PT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:M
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-0505
Mailing Address - Country:US
Mailing Address - Phone:971-219-7059
Mailing Address - Fax:877-863-4623
Practice Address - Street 1:984 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4633
Practice Address - Country:US
Practice Address - Phone:503-325-2134
Practice Address - Fax:877-863-4623
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0605352Medicaid
MAY66615OtherBLUE CROSS/BLUE SHIELD OF MASSACHUSETTS