Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | P1 60084113 | WA |
NPI | 1003041096 |
---|---|
Provider Name | Thomas Hagan |
First Address | Enumclaw, WA 98022-0224 |
Second Address | Enumclaw, WA 98022-7347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2009 |
Last Update Date | 20/05/2009 |