1073122792 NPI number — JULIE BERNICE LUM PT, DPT, OCS

Table of content: JULIE BERNICE LUM PT, DPT, OCS (NPI 1073122792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073122792 NPI number — JULIE BERNICE LUM PT, DPT, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUM
Provider First Name:
JULIE
Provider Middle Name:
BERNICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, OCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARNER
Provider Other First Name:
JULIE
Provider Other Middle Name:
BERNICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073122792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
335 SE 8TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97123-4246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-359-6145
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2333 PACIFIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST GROVE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97116-2449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-359-6145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  60713 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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