Provider Demographics
NPI:1134196694
Name:MARSHALL-BROOK, LYNNE R (MSPT)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:R
Last Name:MARSHALL-BROOK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3728
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-3728
Mailing Address - Country:US
Mailing Address - Phone:503-753-1537
Mailing Address - Fax:503-573-8004
Practice Address - Street 1:18019 SW LOWER BOONES FERRY ROAD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7228
Practice Address - Country:US
Practice Address - Phone:503-753-1537
Practice Address - Fax:503-573-8004
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2600225100000X
OR4179225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R49691Medicare UPIN
R49691Medicare UPIN