Provider Demographics
NPI:1043840424
Name:ROHRER, TRACY (RD / LDN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:ROHRER
Suffix:
Gender:F
Credentials:RD / LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-0929
Mailing Address - Country:US
Mailing Address - Phone:423-238-9636
Mailing Address - Fax:423-238-7095
Practice Address - Street 1:5731 MAIN ST
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8713
Practice Address - Country:US
Practice Address - Phone:423-238-9636
Practice Address - Fax:423-238-7095
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered