Provider Demographics
NPI:1881706679
Name:BRAUN, MATTHEW (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BRAUN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 NE 120TH PL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4283
Mailing Address - Country:US
Mailing Address - Phone:425-825-5902
Mailing Address - Fax:425-925-9703
Practice Address - Street 1:9720 NE 120TH PL
Practice Address - Street 2:SUITE 130
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4283
Practice Address - Country:US
Practice Address - Phone:425-825-5902
Practice Address - Fax:425-925-9703
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT9455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8395667Medicaid
WA187268OtherLABOR & INDUSTRIES
WA8395667Medicaid