Provider Demographics
NPI:1477889905
Name:MALIKOWSKI, TRACY S (LMP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:S
Last Name:MALIKOWSKI
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 1:520 11TH ST NE
Mailing Address - Street 2:APT. 26
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4285
Mailing Address - Country:US
Mailing Address - Phone:917-257-6889
Mailing Address - Fax:
Practice Address - Street 1:520 11TH ST NE
Practice Address - Street 2:APT. 26
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4285
Practice Address - Country:US
Practice Address - Phone:917-257-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-17
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60107613172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist