Provider Demographics
NPI:1750542122
Name:BLUHM, TRACEY JOANNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:JOANNE
Last Name:BLUHM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 TWIN PEAK DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-8065
Mailing Address - Country:US
Mailing Address - Phone:360-751-2935
Mailing Address - Fax:
Practice Address - Street 1:1700 HUDSON ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2930
Practice Address - Country:US
Practice Address - Phone:360-504-0122
Practice Address - Fax:360-859-1354
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7479225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant