Provider Demographics
NPI:1841452042
Name:MOYLE, GLENATH ELEANOR (LMT, NCBTMB)
Entity type:Individual
Prefix:
First Name:GLENATH
Middle Name:ELEANOR
Last Name:MOYLE
Suffix:
Gender:F
Credentials:LMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25561
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97298-0561
Mailing Address - Country:US
Mailing Address - Phone:503-641-2070
Mailing Address - Fax:503-213-5941
Practice Address - Street 1:4931 SW CHESTNUT PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3570
Practice Address - Country:US
Practice Address - Phone:503-641-2070
Practice Address - Fax:503-213-5941
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4198225700000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist