Provider Demographics
NPI:1386212066
Name:PAUL, TANNER (DPT)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DENNIS ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6523
Mailing Address - Country:US
Mailing Address - Phone:360-338-0181
Mailing Address - Fax:
Practice Address - Street 1:6108 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6613
Practice Address - Country:US
Practice Address - Phone:206-524-4977
Practice Address - Fax:206-524-4340
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist