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Individual

MRS. SALLY MARIE MOEGGENBERG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MPT

Contact information

Practice address
3101 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3009
(503) 221-3429
Mailing address
4063 SE ASH ST, PORTLAND, OR 97214-2017
(503) 234-3503

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
2422
OR

Other

Enumeration date
09/17/2010
Last updated
09/17/2010
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