Provider Demographics
NPI:1437581170
Name:SWIFT, MEGAN BREANNE (PT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BREANNE
Last Name:SWIFT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:BREANNE
Other - Last Name:KEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:631 ELM ST SW
Practice Address - Street 2:SUITE 205
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1952
Practice Address - Country:US
Practice Address - Phone:541-967-1224
Practice Address - Fax:541-967-2750
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1437581170Medicaid
ORP01519085OtherRR MEDICARE
OR0330368OtherWA L&I
OR0330372OtherWA L&I
OR500661176Medicaid
OR0330369OtherWA L&I
ORP01519085OtherRR MEDICARE
OR500661176Medicaid
ORR177400Medicare PIN