Provider Demographics
NPI:1487844163
Name:WILWERT, TRACY (PT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WILWERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 S RIDGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-9584
Mailing Address - Country:US
Mailing Address - Phone:360-457-1683
Mailing Address - Fax:
Practice Address - Street 1:124 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3350
Practice Address - Country:US
Practice Address - Phone:360-683-0632
Practice Address - Fax:360-681-5483
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist