Tracy Berg, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160043890 Issued in WA

Practice address

250 G St
Blaine, WA 98230-4019

Phone

(360) 332-8167

NPI assigned

Sep 14, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tracy Smith Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Whatcom Physical Therapy Inc PS

  • Physical Therapist
  • Blaine, WA
  • NPI 1184683948
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284422400000",
    "number": "1134437023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4618 BEDFORD AVE",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982261207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 G ST",
            "city": "BLAINE",
            "state": "WA",
            "postal_code": "982304019",
            "telephone_number": "360-332-8167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "TRACY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-14",
        "last_updated": "2010-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160043890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "SMITH",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapy Assistant in Blaine, WA
• Providers in Blaine, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.