Provider Demographics
NPI:1245772219
Name:TOMPKINS, BRANDON (LMP)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11416 105TH AVE SW
Mailing Address - Street 2:APT G6
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1308
Mailing Address - Country:US
Mailing Address - Phone:253-881-7201
Mailing Address - Fax:
Practice Address - Street 1:11416 105TH AVE SW
Practice Address - Street 2:APT G6
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-1308
Practice Address - Country:US
Practice Address - Phone:253-881-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60708332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist