Individual
BRIAN A THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, OCS, SCS, COMT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00007968
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
306726
L&I PROVIDER ID
WA
05
—
7092208
—
WA
Enumeration date
08/25/2005
Last updated
05/21/2013
Update your record
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