Provider Demographics
NPI:1801125851
Name:BURTON, BRANDON L (LMP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:L
Last Name:BURTON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 ROY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4219
Mailing Address - Country:US
Mailing Address - Phone:206-285-1068
Mailing Address - Fax:206-285-0821
Practice Address - Street 1:557 ROY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4219
Practice Address - Country:US
Practice Address - Phone:206-285-1068
Practice Address - Fax:206-285-0821
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023246225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist