Provider Demographics
NPI:1609815331
Name:BILLINGTON, BRAD WAYNE (PT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:WAYNE
Last Name:BILLINGTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:WAYNE
Other - Last Name:BILLINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:185 W 4TH AVE STE C
Mailing Address - Street 2:PHYSICAL THERAPY CENTER OF POST FALLS
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4979
Mailing Address - Country:US
Mailing Address - Phone:208-777-8851
Mailing Address - Fax:
Practice Address - Street 1:185 W 4TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4978
Practice Address - Country:US
Practice Address - Phone:208-777-8851
Practice Address - Fax:208-777-8851
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT 266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805136200Medicaid
ID1651019Medicare UPIN