Healthcare Provider Details

I. General information

NPI: 1649595786
Provider Name (Legal Business Name): MARC MASAYOSHI MORISHIGE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SE POWELL VALLEY RD
GRESHAM OR
97080-1494
US

IV. Provider business mailing address

PO BOX 647
GRESHAM OR
97030-0167
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-5050
  • Fax: 503-666-5768
Mailing address:
  • Phone: 503-666-5050
  • Fax: 503-666-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1907
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: