MEDICARE: BRANDON BALMELLI DPT

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
1	225100000X	Physical Therapist	PT61135267	WA

General Provider Information

NPI Number	:	1659965382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON BALMELLI DPT

Provider Business Mailing Address
First Line	:	6710 108TH AVE NE STE 100
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7050
Country	:	US
Telephone Number	:	425-979-7445
Fax Number	:	425-947-8540

Provider Business Practice Location Address
First Line	:	6710 108TH AVE NE STE 100
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7050
Country	:	US
Telephone Number	:	425-979-7445
Fax Number	:	425-947-8540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	02/23/2021

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Directions to “ BRANDON BALMELLI DPT” Practice Location

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