Provider Demographics
NPI:1043809957
Name:MUELLER, TRACY RENE (LPTA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:RENE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2758
Mailing Address - Country:US
Mailing Address - Phone:734-755-6809
Mailing Address - Fax:
Practice Address - Street 1:100 POWELL DR
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-8644
Practice Address - Country:US
Practice Address - Phone:734-430-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000605225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant