Provider Demographics
NPI:1497047286
Name:YOSHIDA, BRYN ZACHARY (DPT)
Entity Type:Individual
Prefix:
First Name:BRYN
Middle Name:ZACHARY
Last Name:YOSHIDA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:3912 10TH ST SE
Practice Address - Street 2:#101
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2188
Practice Address - Country:US
Practice Address - Phone:253-848-4700
Practice Address - Fax:253-848-2284
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60220920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0291641OtherDEPT. OF LABOR AND INDUSTRIES
WAP01182296OtherMEDICARE RAILROAD
WA1497047286Medicaid
WA1497047286Medicaid