Active NPI
Sally Marie Moeggenberg, MPT
- Pediatric Physical Therapist
- Portland, OR
National Provider Identifier
1689982126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 2422
- Practice address
- 3101 SW Sam Jackson Park Rd
Portland, OR 97239-3009 - Phone
- (503) 221-3429
- NPI assigned
- Sep 17, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 2422 | OR | Primary |
Addresses
Primary practice location
3101 SW Sam Jackson Park Rd
Portland, OR 97239-3009
Mailing address
4063 SE Ash St
Portland, OR 97214-2017
Phone (503) 234-3503
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2422 | OR | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284681600000",
"number": "1689982126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4063 SE ASH ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972142017",
"telephone_number": "503-234-3503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3101 SW SAM JACKSON PARK RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393009",
"telephone_number": "503-221-3429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOEGGENBERG",
"first_name": "SALLY",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-17",
"last_updated": "2010-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "OR",
"license": "2422",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.