Provider Demographics
NPI:1992042618
Name:PARHAM, TRACI MARIE (PT)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:MARIE
Last Name:PARHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:MARIE
Other - Last Name:SCHOEBERL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:18515 95TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2050
Mailing Address - Country:US
Mailing Address - Phone:253-691-5471
Mailing Address - Fax:
Practice Address - Street 1:516 23RD AVENUE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:253-845-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist