Provider Demographics
NPI:1649252164
Name:GEORGE, BRENT M (MPT)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 77TH AVE SE
Mailing Address - Street 2:STE 214
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2832
Mailing Address - Country:US
Mailing Address - Phone:206-518-9405
Mailing Address - Fax:888-446-7044
Practice Address - Street 1:2737 77TH AVE SE
Practice Address - Street 2:STE 214
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2832
Practice Address - Country:US
Practice Address - Phone:206-518-9405
Practice Address - Fax:888-446-7044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000056812251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0071593OtherLABOR AND INDUSTRIES
WAGE0814OtherREGENCE BLUE SHIELD