Provider Demographics
NPI:1962105163
Name:GUINN, BRADY (LMT)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:GUINN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6663 RYKOSA LN
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4301
Mailing Address - Country:US
Mailing Address - Phone:360-298-4789
Mailing Address - Fax:
Practice Address - Street 1:1004 M AVE STE 111
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1954
Practice Address - Country:US
Practice Address - Phone:360-298-4789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61224151225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist