=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932656287
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER ROSE BRIANT DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2016
-----------------------------------------------------
Last Update Date | 09/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 112TH AVE NE SUITE C260
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-3732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-462-5006
-----------------------------------------------------
Fax | 425-462-5019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 MADISON ST SUITE 901
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-1172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-264-8100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT60657463
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------