Provider Demographics
NPI:1467669861
Name:SMOLSNIK, TRACY ANN (LMP)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:SMOLSNIK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 SE EVERETT MALL WAY STE B
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3734
Mailing Address - Country:US
Mailing Address - Phone:425-337-5588
Mailing Address - Fax:425-355-2138
Practice Address - Street 1:713 SE EVERETT MALL WAY STE B
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3734
Practice Address - Country:US
Practice Address - Phone:425-337-5588
Practice Address - Fax:425-355-2138
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010170225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist