Provider Demographics
NPI:1578810610
Name:ELLGEN, BRYCE CAMERON (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:CAMERON
Last Name:ELLGEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6015 W CROWCHIEF CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9312
Mailing Address - Country:US
Mailing Address - Phone:509-448-9358
Mailing Address - Fax:509-448-5973
Practice Address - Street 1:702 S PARK ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-7025
Practice Address - Country:US
Practice Address - Phone:509-276-2005
Practice Address - Fax:509-276-5550
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPT60290555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist