Tracy Jo Ellis, LMT

NPI #1649664442 in Hayden Lake, Idaho

Provider Information

NPI Number: 1649664442
Entity Type: Individual
Name: Tracy Jo Ellis, LMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Contractor
Credential: LMT
Enumeration Date: Mar 19, 2015
Last Updated: Mar 19, 2015

Practice Location

Address: 157 W HAYDEN AVE
City: Hayden Lake
State: Idaho
ZIP Code: 83835-9650
Phone: (509) 216-3663

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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