Provider Demographics
NPI:1710430228
Name:SHINK, BRANDON (PT , DPT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:SHINK
Suffix:
Gender:M
Credentials:PT , DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W EVERGREEN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6542 SE LAKE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2244
Practice Address - Country:US
Practice Address - Phone:503-427-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65514225100000X
AK112017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist