Provider Demographics
NPI:1316386154
Name:THOMSON, TRACIE L (LMP)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:L
Last Name:THOMSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 W JAMES ST
Mailing Address - Street 2:SE 104
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4600
Mailing Address - Country:US
Mailing Address - Phone:253-266-8560
Mailing Address - Fax:
Practice Address - Street 1:1048 W JAMES ST
Practice Address - Street 2:STE 104
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4600
Practice Address - Country:US
Practice Address - Phone:253-266-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60369802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist