Individual
MR. WENDY MICHEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA PHYSICAL THERAPY
Contact information
Practice address
2701 NW VAUGHN ST, MONTGOMERY PARK OFFICE, PORTLAND, OR 97210-5311
(503) 499-5200
Mailing address
14257 EDENBERRY DR, LAKE OSWEGO, OR 97035-6700
(503) 639-6014
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2036
OR
225100000X
Physical Therapist
PT00006261
WA
Other
Enumeration date
08/18/2006
Last updated
07/08/2007
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