Provider Demographics
NPI:1780138263
Name:NACCARATO, CONNOR LAVANN (DPT, MTC, CSCS)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:LAVANN
Last Name:NACCARATO
Suffix:
Gender:M
Credentials:DPT, MTC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2540
Mailing Address - Country:US
Mailing Address - Phone:253-336-2040
Mailing Address - Fax:253-778-6992
Practice Address - Street 1:2909 S 12TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2540
Practice Address - Country:US
Practice Address - Phone:253-722-9788
Practice Address - Fax:253-778-6992
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist