Provider Demographics
NPI:1346518172
Name:PTACEK, GAIL (LAC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:PTACEK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 DRUMMUIR RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-8612
Mailing Address - Country:US
Mailing Address - Phone:360-579-2157
Mailing Address - Fax:
Practice Address - Street 1:3690 DRUMMUIR RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8612
Practice Address - Country:US
Practice Address - Phone:360-579-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 00000050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist