Individual
KEAGAN TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
7727 40TH ST W STE A, UNIVERSITY PLACE, WA 98466-3146
(253) 460-1362
Mailing address
6050 TACOMA MALL BLVD STE 300, TACOMA, WA 98409-6828
(253) 581-5200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT61001367
WA
Other
Enumeration date
09/26/2019
Last updated
09/26/2019
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