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Individual
TRACY EDWARD TEAGUE
Active
Individual
TRACY EDWARD TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00005870
WA
2251X0800X
Orthopedic Physical Therapist
PT00005870
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT00005870
PT LICENSE
WA
Enumeration date
09/21/2007
Last updated
01/29/2019
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