Provider Demographics
NPI:1760248686
Name:WEN, BRANDON (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:WEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10715 NE 37TH CT APT 309
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-1706
Mailing Address - Country:US
Mailing Address - Phone:615-887-5963
Mailing Address - Fax:
Practice Address - Street 1:11901 NE VILLAGE PLZ STE 261
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5092
Practice Address - Country:US
Practice Address - Phone:425-814-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61536606208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation