Individual
EMILY THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5535 S WILLIAMSON BLVD, PORT ORANGE, FL 32128-8311
(888) 265-2680
Mailing address
826 NE ROSELAWN ST, PORTLAND, OR 97211-3833
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT60568817
WA
Other
Enumeration date
08/29/2017
Last updated
08/29/2017
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