Provider Demographics
NPI:1073056529
Name:MCCALLISTER GILL, TRACY LEIGH (ATC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LEIGH
Last Name:MCCALLISTER GILL
Suffix:
Gender:F
Credentials:ATC
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 1000
Mailing Address - Street 2:CM 77
Mailing Address - City:ATHENS
Mailing Address - State:WV
Mailing Address - Zip Code:24712
Mailing Address - Country:US
Mailing Address - Phone:304-384-5954
Mailing Address - Fax:304-384-5117
Practice Address - Street 1:1000 VERMILLION ST.
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:WV
Practice Address - Zip Code:24712
Practice Address - Country:US
Practice Address - Phone:304-384-5954
Practice Address - Fax:304-384-5117
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0011122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer