Provider Demographics
NPI:1033634068
Name:KONDRACKI, AARON JASON (LMT)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:JASON
Last Name:KONDRACKI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 181ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-4435
Mailing Address - Country:US
Mailing Address - Phone:425-870-6793
Mailing Address - Fax:
Practice Address - Street 1:1808 181ST AVE NE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-4435
Practice Address - Country:US
Practice Address - Phone:425-870-6793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60778312225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60778312OtherWASHINGTON DEPARTMENT OF HEALTH