MEDICARE: SKYHOOK FITNESS

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1407498918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYHOOK FITNESS

Provider Business Mailing Address
First Line	:	12008 SW GARDEN PL
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-8263
Country	:	US
Telephone Number	:	503-740-7588
Fax Number	:

Provider Business Practice Location Address
First Line	:	5836 SW GUNTHER LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-7148
Country	:	US
Telephone Number	:	503-740-7588
Fax Number	:	503-794-5905

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. LYNN KNOPE
Credential	:	PSY
Telephone Number	:	503-740-7588

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	11/16/2025

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Directions to “SKYHOOK FITNESS ” Practice Location

Language	Start Address	Practice Location

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