Provider Demographics
NPI:1356942221
Name:BRAINARD, JOSEPH CODY (DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CODY
Last Name:BRAINARD
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 1:4416 NE SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1446
Mailing Address - Country:US
Mailing Address - Phone:503-449-3763
Mailing Address - Fax:
Practice Address - Street 1:4416 NE SIMPSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1446
Practice Address - Country:US
Practice Address - Phone:503-449-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CA299811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist