Healthcare Provider Details

I. General information

NPI: 1790095446
Provider Name (Legal Business Name): JAMIE STOTTS MRAZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 A JACKSON AVE
TACOMA WA
98431-3260
US

IV. Provider business mailing address

9040 A JACKSON AVE
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1518
  • Fax:
Mailing address:
  • Phone: 253-968-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005950
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: