Provider Demographics
NPI:1780119362
Name:BROWN, PAUL ALAN JR
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17316 SE 185TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9572
Mailing Address - Country:US
Mailing Address - Phone:425-306-9282
Mailing Address - Fax:
Practice Address - Street 1:202 S 348TH ST STE 4
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7070
Practice Address - Country:US
Practice Address - Phone:253-874-2498
Practice Address - Fax:253-248-1909
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60712833225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist