Healthcare Provider Details

I. General information

NPI: 1215128566
Provider Name (Legal Business Name): BRETT BARNTS CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LILLY RD NE STE A
OLYMPIA WA
98506-5031
US

IV. Provider business mailing address

208 LILLY RD NE STE A
OLYMPIA WA
98506-5031
US

V. Phone/Fax

Practice location:
  • Phone: 360-459-1099
  • Fax: 360-459-1794
Mailing address:
  • Phone: 360-459-1099
  • Fax: 360-459-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOI00000331
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS00000322
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: