Provider Demographics
NPI:1154438687
Name:TREAKLE-CHASE, EMILY (LMT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TREAKLE-CHASE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:TREAKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1210 SLEATER KINNEY RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-352-4511
Mailing Address - Fax:
Practice Address - Street 1:1210 SLEATER KINNEY RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-352-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022216225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist