Healthcare Provider Details

I. General information

NPI: 1013825488
Provider Name (Legal Business Name): BREYNDON KEKOA SHIGEO NAKAMURA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 RAINIER AVE S # 102
SEATTLE WA
98118-2498
US

IV. Provider business mailing address

5620 RAINIER AVE S # 102
SEATTLE WA
98118-2498
US

V. Phone/Fax

Practice location:
  • Phone: 206-535-8061
  • Fax: 206-535-8064
Mailing address:
  • Phone: 206-535-8061
  • Fax: 206-535-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT70168455
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: