Brian A Thacker, DPT, OCS, SCS, COMT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00007968 Issued in WA

Practice address

17520 Meridian E
Ste F
Puyallup, WA 98375-6265

Phone

(253) 864-7595

Fax

(253) 864-0457

NPI assigned

Aug 25, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Multicare Health System

  • Neurological Surgery Physician
  • Tacoma, WA
  • NPI 1497766638
  Medicare reassignment NPD
• Multicare Health System

  • Family Medicine Physician
  • Covington, WA
  • NPI 1093768657

  Physical Therapist

  NPD
• Multicare Health System

  • Community/Retail Pharmacy
  • Spokane, WA
  • NPI 1396594875
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369094400000",
    "number": "1376536243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24283",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981240283",
            "telephone_number": "253-581-5200",
            "fax_number": "253-581-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17520 MERIDIAN E",
            "address_2": "STE F",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983756265",
            "telephone_number": "253-864-7595",
            "fax_number": "253-864-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "BRIAN",
        "middle_name": "A",
        "credential": "DPT, OCS, SCS, COMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2013-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00007968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER ID",
            "identifier": "306726",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7092208",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teresa L Lane, RN - Nursing Services
• Kevin Lynn Terry, D.C.
• Tyson Terry
• Lori L Teselle-Delisa, MA
• Kimberly Tevis, ATC
• Hannah Christine Thayer, LMP
• The Blue Cross Medical Transportation
• The Chiropractic Place, P.S.
• The Ida Karlin Pediatric Center
• The Massage and Bodywork Company LLC

• Physical Therapist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.