Healthcare Provider Details

I. General information

NPI: 1669449153
Provider Name (Legal Business Name): TIGARD PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SW PACIFIC HWY
PORTLAND OR
97223-6136
US

IV. Provider business mailing address

PO BOX 3728
TUALATIN OR
97062-3728
US

V. Phone/Fax

Practice location:
  • Phone: 503-753-1537
  • Fax: 503-573-8004
Mailing address:
  • Phone: 503-753-1537
  • Fax: 503-573-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7585
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2600
License Number StateOR

VIII. Authorized Official

Name: LYNNE R MARSHALL-BROOK
Title or Position: PRESIDENT
Credential:
Phone: 503-753-1537