Provider Demographics
NPI:1245606854
Name:THAO, BAO (LMP)
Entity Type:Individual
Prefix:
First Name:BAO
Middle Name:
Last Name:THAO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 NE 55TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2168
Mailing Address - Country:US
Mailing Address - Phone:360-566-7133
Mailing Address - Fax:360-944-0144
Practice Address - Street 1:917 NE 192ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-896-6037
Practice Address - Fax:360-944-0144
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60578261225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist