Provider Demographics
NPI:1295772671
Name:CALLAN, BRAD (MSPT)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:CALLAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1188 106TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8614
Mailing Address - Country:US
Mailing Address - Phone:425-454-4864
Mailing Address - Fax:425-646-3901
Practice Address - Street 1:405 NW GILMAN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2470
Practice Address - Country:US
Practice Address - Phone:425-392-6804
Practice Address - Fax:425-392-6805
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00008322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7131931Medicaid
WA7131931Medicaid
WAG8905353Medicare PIN