Healthcare Provider Details

I. General information

NPI: 1104300656
Provider Name (Legal Business Name): BRENDEN D THOMPSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MCNARY ESTATES DR N
KEIZER OR
97303-7459
US

IV. Provider business mailing address

685 36TH AVE NE
SALEM OR
97301-4741
US

V. Phone/Fax

Practice location:
  • Phone: 503-463-4231
  • Fax: 503-463-5175
Mailing address:
  • Phone: 503-371-8860
  • Fax: 503-371-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62927
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: