Provider Demographics
NPI:1649601907
Name:WILSON, BRENDAN CHARLES (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:CHARLES
Last Name:WILSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4930 W KAWEAH CT
Mailing Address - Street 2:203
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8324
Mailing Address - Country:US
Mailing Address - Phone:559-713-6806
Mailing Address - Fax:559-713-6809
Practice Address - Street 1:230 GRANT RD STE B27
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7715
Practice Address - Country:US
Practice Address - Phone:509-884-1437
Practice Address - Fax:509-884-2811
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist