Provider Demographics
NPI:1922564293
Name:BRANDT, KODY ALLEN (DPT)
Entity type:Individual
Prefix:
First Name:KODY
Middle Name:ALLEN
Last Name:BRANDT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E YAKIMA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2627
Mailing Address - Country:US
Mailing Address - Phone:509-540-3244
Mailing Address - Fax:509-219-6002
Practice Address - Street 1:201 E YAKIMA AVE STE 101
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2627
Practice Address - Country:US
Practice Address - Phone:509-540-3244
Practice Address - Fax:509-219-6002
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60920832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist