Provider Demographics
NPI:1124446471
Name:MCCABE, BRYAN (ATC, NASE, PES)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:MCCABE
Suffix:
Gender:M
Credentials:ATC, NASE, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N PUGET SOUND AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5852
Mailing Address - Country:US
Mailing Address - Phone:714-488-4939
Mailing Address - Fax:
Practice Address - Street 1:7308 BRIDGEPORT WAY W STE 103
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8000
Practice Address - Country:US
Practice Address - Phone:253-582-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1 60284579390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program