Healthcare Provider Details

I. General information

NPI: 1417651118
Provider Name (Legal Business Name): CHRISTOPHER BRANDON PUTRZENSKI LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 FOWLER ST
RICHLAND WA
99352-4833
US

IV. Provider business mailing address

5216 BAKERLOO LN
PASCO WA
99301-6638
US

V. Phone/Fax

Practice location:
  • Phone: 509-396-3980
  • Fax:
Mailing address:
  • Phone: 206-380-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61361356
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: