Provider Demographics
NPI:1619456357
Name:TANIGUCHI, RYAN KOICHI (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:KOICHI
Last Name:TANIGUCHI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329 N 26TH ST APT B1
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-1410
Mailing Address - Country:US
Mailing Address - Phone:808-895-4231
Mailing Address - Fax:
Practice Address - Street 1:26837 MAPLE VALLEY BLACK DIAMOND RD SE STE 200
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038
Practice Address - Country:US
Practice Address - Phone:425-413-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60851322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist