Provider Demographics
NPI:1134369671
Name:DEFENBAUGH, BRAD S (DPT)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:S
Last Name:DEFENBAUGH
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 1:1 LAKE BELLEVUE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2417
Mailing Address - Country:US
Mailing Address - Phone:425-462-4330
Mailing Address - Fax:425-462-4335
Practice Address - Street 1:1 LAKE BELLEVUE DR
Practice Address - Street 2:STE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2417
Practice Address - Country:US
Practice Address - Phone:425-462-4330
Practice Address - Fax:425-462-4335
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60273792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070016925OtherILLINOIS PT LICENSE