MEDICARE: PACIFIC UNIVERSITY

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	2251S0007X	Sports Physical Therapist
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1811363310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC UNIVERSITY

Provider Business Mailing Address
First Line	:	2043 COLLEGE WAY
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1756
Country	:	US
Telephone Number	:	503-352-2705
Fax Number	:

Provider Business Practice Location Address
First Line	:	2142 COLLEGE WAY
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1727
Country	:	US
Telephone Number	:	503-352-2269
Fax Number	:	503-352-3105

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	LISA DOWNING
Credential	:	NCMA
Telephone Number	:	503-352-2663

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/20/2024

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Directions to “PACIFIC UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

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