Individual
BRIAN TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1215 SE 8TH AVE STE D, PORTLAND, OR 97214-3497
(503) 248-0360
(503) 200-1148
Mailing address
1215 SE 8TH AVE STE D, PORTLAND, OR 97214-3497
(503) 248-0360
(503) 200-1148
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
63951
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C392786
OREGON DRIVERS LICENSE
OR
Enumeration date
10/18/2022
Last updated
10/18/2022
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