Provider Demographics
NPI:1518396043
Name:AVELLANEDA, BRIAN UZARRAGA (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:UZARRAGA
Last Name:AVELLANEDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11524 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-1726
Mailing Address - Country:US
Mailing Address - Phone:253-719-7485
Mailing Address - Fax:
Practice Address - Street 1:7320 SW HUNZIKER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8283
Practice Address - Country:US
Practice Address - Phone:888-317-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist