Provider Demographics
NPI:1033458310
Name:BATTLE, TRACY KILIAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:KILIAN
Last Name:BATTLE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:TRACY
Other - Middle Name:KILIAN
Other - Last Name:BATTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:171 AVIATION AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3022
Mailing Address - Country:US
Mailing Address - Phone:321-506-9188
Mailing Address - Fax:
Practice Address - Street 1:171 AVIATION AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3022
Practice Address - Country:US
Practice Address - Phone:321-506-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14032225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant