Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT00005763 | WA |
NPI | 1073637856 |
---|---|
Provider Name | Tracie H Baylor |
First Address | Shoreline, WA 98177-2317 |
Second Address | Edmonds, WA 98020-4134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F86424 | (02) | WA |