Healthcare Provider Details

I. General information

NPI: 1619118965
Provider Name (Legal Business Name): TRACY A OBAN BEAR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CEDAR AVE S
NORTH BEND WA
98045-8262
US

IV. Provider business mailing address

34813 SE KINSEY ST G-102
SNOQUALMIE WA
98065-9391
US

V. Phone/Fax

Practice location:
  • Phone: 425-888-2129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: