Healthcare Provider Details

I. General information

NPI: 1295981579
Provider Name (Legal Business Name): BRENT S MUELLER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N EVERGREEN RD STE 10
SPOKANE VALLEY WA
99216-1485
US

IV. Provider business mailing address

15825 SE NEHALEM ST
PORTLAND OR
97236-5350
US

V. Phone/Fax

Practice location:
  • Phone: 509-926-5367
  • Fax:
Mailing address:
  • Phone: 971-322-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5645
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number60293127
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: