Provider Demographics
NPI:1518900174
Name:SIMPSON, BRAD (PT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:SIMPSON
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 1:3786 SW HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2050
Mailing Address - Country:US
Mailing Address - Phone:503-626-6587
Mailing Address - Fax:
Practice Address - Street 1:3786 SW HALL BLVD
Practice Address - Street 2:SUITE160
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2050
Practice Address - Country:US
Practice Address - Phone:503-626-6587
Practice Address - Fax:971-231-2097
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009936225100000X
OR5797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8440729Medicaid
WA8857506Medicare PIN