Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mark Robert Peacock, PTA

Individual provider Physical Therapy Assistant · NPI 1982370094

Mark Robert Peacock, PTA is a Physical Therapy Assistant in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2021.

Licensed in
OR
In the registry since
2021
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

6003 SE 136th Ave
Portland, OR 97236-4567
Phone: (971) 978-1268
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 9978 (OR)

Record details

NPI number1982370094
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedAugust 18, 2021
Last updated in NPPESAugust 18, 2021
Certification dateAugust 18, 2021
Mailing address4560 Se International Way Ste 100, Milwaukie, OR 97222-4628

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