Elise Miranda Princehouse Moore, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

63267 Issued in OR

Practice address

602A Front St
Silverton, OR 97381-1428

Phone

(503) 874-4416

NPI assigned

May 24, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Promotion Advanced Functional Rehab LLC

  • Orthopedic Physical Therapist
  • Stayton, OR
  • NPI 1710932710
  Medicare reassignment NPD
• Promotion Advanced Functional Rehab, LLC

  • Physical Therapist
  • Silverton, OR
  • NPI 1689051658
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1235796293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 N 1ST AVE",
            "city": "STAYTON",
            "state": "OR",
            "postal_code": "973831704",
            "telephone_number": "503-769-3123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602A FRONT ST",
            "city": "SILVERTON",
            "state": "OR",
            "postal_code": "973811428",
            "telephone_number": "503-874-4416"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4049 Market St NE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973011902",
            "country_code": "US",
            "telephone_number": "503-689-1530",
            "fax_number": "866-905-9668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRINCEHOUSE MOORE",
        "first_name": "ELISE",
        "middle_name": "MIRANDA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-24",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "63267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pill Box Drugs Inc
• Andrew Scott Pitman, LMT
• Jennifer Poindexter, ND
• Premier Nemt
• Amy Diann Price
• Promotion Advanced Functional Rehab, LLC
• Providence Silverton Rehab LLC
• Brian E Puerling, NP
• Mary Purdy, PBP, BSN, RES-CPT
• Sharon Louise Purtymun, LMT

• Physical Therapist in Silverton, OR
• Providers in Silverton, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.