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NPI Code Detail

MEDICARE: JORDAN P PASCUA DPT

MEDICARE: JORDAN P PASCUA DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT.PT.70150967-CPWA
2225100000XPhysical Therapist14221457-2401UT
3225100000XPhysical Therapist66143OR

General Provider Information

NPI Number : 1043144991
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN P PASCUA DPT
Provider Business Mailing Address
First Line : 3710 SW US VETERANS HOSPITAL RD RM 1C-194A
Second Line :
City : PORTLAND
State : OR
Zip : 97239-2964
Country : US
Telephone Number : 503-273-5018
Fax Number :
Provider Business Practice Location Address
First Line : 3710 SW US VETERANS HOSPITAL RD RM 1C-194A
Second Line :
City : PORTLAND
State : OR
Zip : 97239-2964
Country : US
Telephone Number : 503-273-5018
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/26/2026

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