Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Lyndsay Provencio, PT

Individual provider Physical Therapist · NPI 1174001887

Lyndsay Provencio, PT is a Physical Therapist in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2018.

Licensed in
OR
In the registry since
2018
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

4829 NE Mlk Jr Blvd Ste 101
Portland, OR 97211-3491
Phone: (503) 283-8133
Fax: (503) 287-0245
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 62930 (OR)

Record details

NPI number1174001887
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT
Sole proprietorNo
NPI enumeratedAugust 3, 2018
Last updated in NPPESSeptember 20, 2018

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