Provider Demographics
NPI:1962959965
Name:VISSER, JOSEPH RYAN (DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYAN
Last Name:VISSER
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 1:1900 SW CAMPUS DR
Mailing Address - Street 2:APT 1-105
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6533
Mailing Address - Country:US
Mailing Address - Phone:435-979-8327
Mailing Address - Fax:
Practice Address - Street 1:1407 E 72ND ST
Practice Address - Street 2:STE A-100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-5906
Practice Address - Country:US
Practice Address - Phone:253-474-7474
Practice Address - Fax:253-474-7479
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60666394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist