Provider Demographics
NPI:1093840951
Name:PURCELL, TRACY A (MS ATC CKTP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:PURCELL
Suffix:
Gender:F
Credentials:MS ATC CKTP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:A
Other - Last Name:PORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HB 6083 ALUMNI HALL
Mailing Address - Street 2:DARTMOUTH COLLEGE
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755
Mailing Address - Country:US
Mailing Address - Phone:603-646-2472
Mailing Address - Fax:603-646-6455
Practice Address - Street 1:1 CROSBY ST.
Practice Address - Street 2:DAVIS VARSITY HOUSE
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755
Practice Address - Country:US
Practice Address - Phone:603-646-2472
Practice Address - Fax:603-646-6455
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer