Provider Demographics
NPI:1285921148
Name:MOORE, CHANDRIKA M (DPT)
Entity type:Individual
Prefix:
First Name:CHANDRIKA
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHANDI
Other - Middle Name:M
Other - Last Name:BICKFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:18122 SW LOWER BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7216
Mailing Address - Country:US
Mailing Address - Phone:503-639-2118
Mailing Address - Fax:503-639-7688
Practice Address - Street 1:18122 SW LOWER BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7216
Practice Address - Country:US
Practice Address - Phone:503-639-2118
Practice Address - Fax:503-639-7688
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist