Healthcare Provider Details

I. General information

NPI: 1134196694
Provider Name (Legal Business Name): LYNNE R MARSHALL-BROOK MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

12700 SW PACIFIC HWY
TIGARD 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 TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2600
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4179
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: