Tracy Bodhaine, LMP
Individual provider Active NPI Massage Therapist · Kent, WA
NPI 1386945756 · NPPES record last updated Nov 16, 2010
Key facts
- NPI
- 1386945756
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MA00015450 (WA)
- Practice address
- 15220 SE 272ND St
Suite G
Kent, WA 98042-4241 - Phone
- (253) 630-6768
- NPI assigned
- Nov 16, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00015450 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elle a Clinical Day Spa, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA00015450 | WA | Yes |
Addresses
Primary practice location
15220 SE 272ND St
Suite G
Kent, WA 98042-4241
Mailing address
15220 SE 272ND St
Suite G
Kent, WA 98042-4241
Phone (253) 630-6768
Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.