# TGB PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tyler Baca PHYSIO
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992582191
- **Authorized official:** TYLER BACA DPT (PHYSICAL THERAPIST/ OWNER)
- **Authorized official phone:** (805) 728-5894

## Contact information

- **Practice address:** 4400 SW MULTNOMAH BLVD, PORTLAND, OR 97219-3558
- **Practice address phone:** (503) 208-4413
- **Mailing address:** 4400 SW MULTNOMAH BLVD, PORTLAND, OR 97219-3558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/11/2023
- **Last updated:** 09/11/2023