Active NPI
Marvan Lim
- Physical Therapist
- Wilsonville, OR
National Provider Identifier
1447370770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 0284111
- Practice address
- 25117 SW Parkway Ave
Suite D
Wilsonville, OR 97070-9697 - Phone
- (503) 570-3665
- NPI assigned
- Mar 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 60232504 | WA | |
| Physical Therapist | 225100000X | 0284111 | NY | Primary |
Addresses
Primary practice location
25117 SW Parkway Ave
Suite D
Wilsonville, OR 97070-9697
Mailing address
4929 155TH PL SW
Edmonds, WA 98026-4859
Phone (917) 213-3222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0284111 | NY | MD | Physical Therapist |
| PT 60232504 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524096000000",
"number": "1447370770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4929 155TH PL SW",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980264859",
"telephone_number": "917-213-3222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25117 SW PARKWAY AVE",
"address_2": "SUITE D",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970709697",
"telephone_number": "503-570-3665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIM",
"first_name": "MARVAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-30",
"last_updated": "2018-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT 60232504",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "0284111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilsonville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.