Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00009376 | WA |
NPI | 1003223629 |
---|---|
Provider Name | Brian Schreck |
First Address | Vancouver, WA 98684-5808 |
Second Address | Vancouver, WA 98684-5808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2014 |
Last Update Date | 15/07/2014 |