IndividualActive
Lyndsay Provencio, PT
NPI 1174001887 · Physical Therapist · Portland, OR
Provider details
- NPI number
- 1174001887
- Entity type
- Individual
- Primary specialty
- Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- PT
- Sex
- Female
- Sole proprietor
- No
- License
- 62930 (OR)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
Established profile(67/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4829 Ne Mlk Jr Blvd Ste 101
Portland, OR 97211-3491
Phone: (503) 283-8133
Fax: (503) 287-0245
Street-level locationGet directions
Mailing address
16083 Sw Upper Boones Ferry Rd Ste 300
Tigard, OR 97224-7736
Registry dates
- Enumerated
- 2018-08-03
- Last updated
- 2018-09-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.