Basic Information
| Provider Information | |||||||||
| NPI: | 1770780678 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | THATCHER | ||||||||
| FirstName: | CARL | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21453 SW ROELLICH AVE | ||||||||
| Address2: | |||||||||
| City: | SHERWOOD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971408245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036256548 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5701 SW MULTNOMAH BLVD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972193195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032441107 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2741 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT00007644 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.