Provider Demographics
NPI:1023185576
Name:COSGROVE, TRACEY (PT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:MS 359107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356490
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-4830
Practice Address - Fax:206-598-4897
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist