Provider Demographics
NPI:1366569626
Name:FORSYTHE, ERIC WILLIAM (ATC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:WILLIAM
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 E BAY DR NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4833 TUMWATER VALLEY DR SE
Practice Address - Street 2:SUITE 150
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4583
Practice Address - Country:US
Practice Address - Phone:360-493-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer