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Individual

BRENT A COBURN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSPT

Contact information

Practice address
13127 121ST WAY NE, F, KIRKLAND, WA 98034-3051
(425) 823-8631
(425) 814-4731
Mailing address
11711 NE 12TH ST, 3 A, BELLEVUE, WA 98005-2461
(425) 450-9474
(425) 452-0704

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00007127
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
116537
L & I
WA
05
7060338
WA
Enumeration date
07/12/2006
Last updated
07/08/2007
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