=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437581170
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN BREANNE SWIFT P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2013
-----------------------------------------------------
Last Update Date | 11/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 631 ELM ST SW SUITE 205
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97321-1952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-967-1224
-----------------------------------------------------
Fax | 541-967-2750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16083 SW UPPER BOONES FERRY RD SUITE 300
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97224-7736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-219-8835
-----------------------------------------------------
Fax | 503-639-9699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 60290
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------