Provider Demographics
NPI:1831421445
Name:MOFFIT, PATRICIA LEE (RN, PTA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:MOFFIT
Suffix:
Gender:F
Credentials:RN, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33175 MCFARLAND RD UNIT 8
Mailing Address - Street 2:
Mailing Address - City:TANGENT
Mailing Address - State:OR
Mailing Address - Zip Code:97389-9648
Mailing Address - Country:US
Mailing Address - Phone:541-791-3258
Mailing Address - Fax:541-791-3258
Practice Address - Street 1:33175 MCFARLAND RD UNIT 8
Practice Address - Street 2:
Practice Address - City:TANGENT
Practice Address - State:OR
Practice Address - Zip Code:97389-9648
Practice Address - Country:US
Practice Address - Phone:541-791-3258
Practice Address - Fax:541-791-3258
Is Sole Proprietor?:No
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200241501RN RN163W00000X
OR7121225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant