NPI 1649664442

Tracy Jo Ellis, LMT

Practitioner Contractor Hayden Lake, ID

Practice location

Address: 157 W Hayden Ave, Hayden Lake, ID 83835-9650
Phone: (509) 216-3663
Mailing address: 1628 W Judy K Dr, Rathdrum, ID 83858-7502

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence MAS-1492 (ID)

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Registry record

NPI: 1649664442
Entity type: Individual
Sex (as registered): Female
NPI issued: 19 Mar 2015
Record last updated: 19 Mar 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.