MEDICARE: ULTRA PHYSICAL THERAPY & HAND CENTER II LLC

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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1679218317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRA PHYSICAL THERAPY & HAND CENTER II LLC

Provider Business Mailing Address
First Line	:	PO BOX 704
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97075-0704
Country	:	US
Telephone Number	:	503-662-6403
Fax Number	:

Provider Business Practice Location Address
First Line	:	16849 SW 65TH AVE
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-7865
Country	:	US
Telephone Number	:	971-249-3168
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MS. AURORE LARIVEN
Credential	:
Telephone Number	:	971-249-3168

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/23/2025

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