Individual
JOHN PAUL MARCEL FAIRHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1118 VIEW AVE, CENTRALIA, WA 98531-1870
(360) 736-5273
(360) 736-5053
Mailing address
4740 AVERY LN SE, LACEY, WA 98503-5603
(360) 736-5273
(360) 736-5053
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT60482042
WA
Other
Enumeration date
09/15/2014
Last updated
11/21/2014
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