Provider Demographics
NPI:1073050779
Name:TRAN, TRACY (DPT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 13TH ST
Mailing Address - Street 2:APT 19
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4832
Mailing Address - Country:US
Mailing Address - Phone:949-419-4776
Mailing Address - Fax:
Practice Address - Street 1:120 E 56TH ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3607
Practice Address - Country:US
Practice Address - Phone:212-759-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040666-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist