Provider Demographics
NPI:1780087171
Name:LEFFERTS, BRIANNE N (PT)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:N
Last Name:LEFFERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:N
Other - Last Name:LINDBLAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:300 SW 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-204-2300
Mailing Address - Fax:
Practice Address - Street 1:300 SW 7TH STREET
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-204-2300
Practice Address - Fax:253-946-4862
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60494908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8936076Medicare UPIN