Provider Demographics
NPI:1548497654
Name:NEILSON, BRETT D (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:D
Last Name:NEILSON
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26837 MAPLE VALLEY BLACK DIAMOND SERD 200
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-9917
Mailing Address - Country:US
Mailing Address - Phone:425-413-4427
Mailing Address - Fax:425-413-4402
Practice Address - Street 1:8009 S 180TH ST
Practice Address - Street 2:STE 112
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1042
Practice Address - Country:US
Practice Address - Phone:425-226-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60095972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00748164OtherRAILROAD MEDICARE
WAG8883868Medicare PIN