Healthcare Provider Details

I. General information

NPI: 1447570809
Provider Name (Legal Business Name): BRANDON BRUCE BENNETT D.P.T., L.A.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 RICH RD SE
OLYMPIA WA
98501-5317
US

IV. Provider business mailing address

6307 RICH RD SE
OLYMPIA WA
98501-5317
US

V. Phone/Fax

Practice location:
  • Phone: 360-587-0686
  • Fax: 360-359-7756
Mailing address:
  • Phone: 360-587-0686
  • Fax: 360-359-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPU 60159680
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPU 60159680
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: