Provider Demographics
NPI:1801006002
Name:POWELL, BRENDA EILEEN BROYLES (PT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:EILEEN BROYLES
Last Name:POWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 SE 146TH PL
Mailing Address - Street 2:#160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5430
Mailing Address - Country:US
Mailing Address - Phone:360-254-6097
Mailing Address - Fax:
Practice Address - Street 1:8507 NE 8TH WAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1980
Practice Address - Country:US
Practice Address - Phone:360-254-5335
Practice Address - Fax:360-892-2086
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist