Provider Demographics
NPI:1578110276
Name:WILLIAMS, BRIAN T (CPO, LPO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 SORENSON RD
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-9622
Mailing Address - Country:US
Mailing Address - Phone:509-607-0873
Mailing Address - Fax:
Practice Address - Street 1:2701 SORENSON RD
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-9622
Practice Address - Country:US
Practice Address - Phone:509-607-0873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000219222Z00000X
WA00000220224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0144247OtherWASHINGTON STATE DEPARTMENT OF LABOR & INDUSTRIES