Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 61415 | OR |
N | 2251N0400X | Physical Therapist - Neurology | 61415 | OR |
N | 2251P0200X | Physical Therapist - Pediatrics | 61415 | OR |
N | 2251S0007X | Physical Therapist - Sports | 61415 | OR |
Y | 2251X0800X | Physical Therapist - Orthopedic | 61415 | OR |
NPI | 1649899675 |
---|---|
Provider Name | Kristin Moore |
First Address | Portland, OR 97239-4501 |
Second Address | Portland, OR 97239-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 09/04/2020 |