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NPI Code Detail

MEDICARE: BRAD CALLAN MSPT

MEDICARE: BRAD CALLAN MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT00008322WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295772671
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAD CALLAN MSPT
Provider Business Mailing Address
First Line : 1188 106TH AVE NE
Second Line : SUITE 100
City : BELLEVUE
State : WA
Zip : 98004-8614
Country : US
Telephone Number : 425-454-4864
Fax Number : 425-646-3901
Provider Business Practice Location Address
First Line : 405 NW GILMAN BLVD
Second Line : SUITE 200
City : ISSAQUAH
State : WA
Zip : 98027-2470
Country : US
Telephone Number : 425-392-6804
Fax Number : 425-392-6805
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 03/14/2012

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Directions to “ BRAD CALLAN MSPT” Practice Location

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