MEDICARE: JACOB L TACHER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT60654649	WA

General Provider Information

NPI Number	:	1205285277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB L TACHER DPT

Provider Business Mailing Address
First Line	:	7201 W CLEARWATER AVE STE B101
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-1694
Country	:	US
Telephone Number	:	509-544-0265
Fax Number	:	509-987-1614

Provider Business Practice Location Address
First Line	:	1342 S PIONEER WAY
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-2410
Country	:	US
Telephone Number	:	509-765-9608
Fax Number	:	509-766-0481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	06/09/2016

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