Provider Demographics
NPI:1629040050
Name:NORVELL, TRACY LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:NORVELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2075 BARKLEY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6696
Mailing Address - Country:US
Mailing Address - Phone:360-733-4008
Mailing Address - Fax:360-733-4064
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6696
Practice Address - Country:US
Practice Address - Phone:360-733-4008
Practice Address - Fax:360-733-4064
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5535634OtherAETNA
WA119894OtherLABOR AND INDUSTRY
WA8327694Medicaid
A006OtherTRICARE
WA40967OtherREGENCE
WA8327694Medicaid
AB16279Medicare ID - Type Unspecified