Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT61221079 | WA |
NPI | 1023774858 |
---|---|
Provider Name | Lucas Evan Brown |
First Address | Bellevue, WA 98005-4571 |
Second Address | Bellevue, WA 98005-4571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2021 |
Last Update Date | 16/11/2021 |