| Doctor Name: | CODY LOMMEN |
| NPI Number: | 1134484603 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 6845 |
| Business Practice Address: | 5955 Shoreview Ln N Ste. 100 Keizer, OR - 973033981 |
| Business Phone Number: | 5034634221 |
| Business Fax Number: | 5034634522 |
| Mailing Address: | 16083 Sw Upper Boones Ferry Rd, Ste. 300 TIGARD |
| State: | OR |
| Postal Code: | 972247736 |
| Phone Number: | 8002198835 |
| Fax Number: | 5036399699 |
| NPI Enumeration Date: | 07/10/2012 |
| NPI Last Update Date: | 11/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 6845 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |