MEDICARE: MAI PHAM 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
1	225100000X	Physical Therapist	4793	OR

General Provider Information

NPI Number	:	1598711236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI PHAM DPT

Provider Business Mailing Address
First Line	:	2875 NW STUCKI AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5806
Country	:	US
Telephone Number	:	971-310-3202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 NW STUCKI AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5806
Country	:	US
Telephone Number	:	971-310-3202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	12/31/2021

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Directions to “ MAI PHAM DPT” Practice Location

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