Provider Demographics
NPI:1982718326
Name:MACNEILL, TRACEY (MPT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:MACNEILL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 NE 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6624
Mailing Address - Country:US
Mailing Address - Phone:425-643-9778
Mailing Address - Fax:425-643-6448
Practice Address - Street 1:13434 NE 16TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2335
Practice Address - Country:US
Practice Address - Phone:425-643-9778
Practice Address - Fax:425-643-6448
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist