Provider Demographics
NPI:1578605374
Name:CLUTE, BRIAN KEITH (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:CLUTE
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 1:800 ALOHA ST
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3100
Mailing Address - Country:US
Mailing Address - Phone:425-771-1774
Mailing Address - Fax:
Practice Address - Street 1:1207 N 200TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3213
Practice Address - Country:US
Practice Address - Phone:206-542-1986
Practice Address - Fax:206-542-1144
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB21464Medicare ID - Type UnspecifiedMEDICARE PART B