Provider Demographics
NPI:1407498918
Name:SKYHOOK FITNESS
Entity Type:Organization
Organization Name:SKYHOOK FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOPE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY
Authorized Official - Phone:503-740-7588
Mailing Address - Street 1:12008 SW GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8263
Mailing Address - Country:US
Mailing Address - Phone:503-740-7588
Mailing Address - Fax:
Practice Address - Street 1:12008 SW GARDEN PL
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8263
Practice Address - Country:US
Practice Address - Phone:503-740-7588
Practice Address - Fax:503-794-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty