Individual
CARL THATCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
5701 SW MULTNOMAH BLVD, PORTLAND, OR 97219-3195
(503) 244-1107
Mailing address
21453 SW ROELLICH AVE, SHERWOOD, OR 97140-8245
(503) 625-6548
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2741
OR
225100000X
Physical Therapist
PT00007644
WA
Other
Enumeration date
07/02/2007
Last updated
07/08/2007
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