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Organization
OLYMPIC SPORTS AND SPINE REHABILITATION, P.S.
Active
Organization
OLYMPIC SPORTS AND SPINE REHABILITATION, P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN THACKER PT (VICE PRESIDENT)
(253) 581-5200
Entity
Organization
Contact information
Practice address
17520 MERIDIAN E, SUITE F, PUYALLUP, WA 98375-6265
(253) 864-7595
(253) 864-0457
Mailing address
9315 GRAVELLY LAKE DR SW, SUITE 306, LAKEWOOD, WA 98499-1574
(253) 581-5200
(253) 581-5203
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225700000X
Massage Therapist
—
—
225X00000X
Occupational Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
12/15/2015
Last updated
12/23/2015
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