Provider Demographics
NPI:1659079796
Name:MACOLOR, GRACIELLA JESSICA RAAGAS
Entity Type:Individual
Prefix:
First Name:GRACIELLA JESSICA
Middle Name:RAAGAS
Last Name:MACOLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACIELLA JESSICA
Other - Middle Name:ARCE
Other - Last Name:RAAGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 6TH AVE APT N1812
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2857
Mailing Address - Country:US
Mailing Address - Phone:206-571-1794
Mailing Address - Fax:
Practice Address - Street 1:820 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-2207
Practice Address - Country:US
Practice Address - Phone:206-356-1532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61300061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist