Basic Information
| Provider Information | |||||||||
| NPI: | 1124446471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCABE | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC, NASE, PES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 N PUGET SOUND AVE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984065852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144884939 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7308 BRIDGEPORT WAY W STE 103 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984998000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535828142 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2014 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | A1 60284579 | WA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.