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General NPI Number Information
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NPI Number | 1669449153
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Entity Type | Organization
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Legal Business Name | TIGARD PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 12700 SW PACIFIC HWY
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City | PORTLAND
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State | OR
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Zip | 97223-6136
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Country | US
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Telephone | 503-753-1537
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Fax | 503-573-8004
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Provider Business Mailing Address
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Address Line | PO BOX 3728
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City | TUALATIN
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State | OR
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Zip | 97062-3728
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Country | US
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Telephone | 503-753-1537
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Fax | 503-573-8004
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Authorized Official
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Title or Position | PRESIDENT
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Name | LYNNE R MARSHALL-BROOK
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Credential |
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Telephone | 503-753-1537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 7585
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2600
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License Number State | OR
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