Jacalyn Breidenbach, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00008243 Issued in WA

Practice address

126 15TH St SE
Puyallup, WA 98372-3409

Phone

(253) 445-8663

Fax

(253) 445-8342

NPI assigned

Aug 24, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Jacalyn Gray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408924800000",
    "number": "1609983972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 140TH AVE NE",
            "address_2": "SUITE 110",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980051862",
            "telephone_number": "425-644-4100",
            "fax_number": "425-644-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 15TH ST SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723409",
            "telephone_number": "253-445-8663",
            "fax_number": "253-445-8342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREIDENBACH",
        "first_name": "JACALYN",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2014-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00008243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0140283",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8332975",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACALYN",
            "last_name": "GRAY",
            "credential": "MPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tyren J Bratvold, D.C.
• Logan Joseph Brau, DO
• Caroline Anne Braun, DNP
• Jason Dean Brayley, M.D.
• Christopher Aaron Breed, M.D.
• Barry Drew Brenden
• Erin Williams Brenner, DPT
• Shawnda L Brese, MA, LMFT
• Earl Edward Brewer, BS-PHYSIAL THERAPY
• Katherine H Brewer, M.D.

• Physical Therapist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.