Provider Demographics
NPI:1346345428
Name:CLOUD, TRACY SEAN (PT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:SEAN
Last Name:CLOUD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 1ST AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4744
Mailing Address - Country:US
Mailing Address - Phone:206-859-5030
Mailing Address - Fax:206-859-5031
Practice Address - Street 1:415 1ST AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4744
Practice Address - Country:US
Practice Address - Phone:206-859-5030
Practice Address - Fax:206-859-5031
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1871357OtherUNITED HEALTHCARE
WA7988015OtherAETNA
WA7988015OtherAETNA