Provider Demographics
NPI:1699976969
Name:HILL, TRACY E (LMP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:E
Last Name:HILL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:E
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:611 W 17TH ST
Mailing Address - Street 2:VANCOUVER
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2837
Mailing Address - Country:US
Mailing Address - Phone:360-936-8999
Mailing Address - Fax:
Practice Address - Street 1:218 W 13TH STREET
Practice Address - Street 2:VANCOUVER
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2906
Practice Address - Country:US
Practice Address - Phone:360-936-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601820164Medicare UPIN