Individual
BRIAN A THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, OCS, SCS, COMT
Contact information
Practice address
17520 MERIDIAN E, STE F, PUYALLUP, WA 98375-6265
(253) 864-7595
(253) 864-0457
Mailing address
PO BOX 24283, SEATTLE, WA 98124-0283
(253) 581-5200
(253) 581-5203
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
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