Peacock, Mark Robert
Peacock, Mark Robert is an individual health care provider with primary practice located at 6003 Se 136Th Ave , Portland OR 97236-4567. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as his primary health care specialty. Peacock, Mark Robert can be contacted via phone (971) 978-1268.Contact Information
Primary practice address
6003 Se 136Th Ave
Portland OR 97236-4567
Phone: (971) 978-1268
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant | 225200000X | 9978 | Oregon |
Profile Details
| NPI number | 1982370094 |
|---|---|
| LBN Legal business name | Peacock, Mark Robert |
| Credentials | Physical Therapist Assistant (PTA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 18th, 2021 |
| Last updated | Aug 18th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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