Provider Demographics
NPI:1104223072
Name:BARNES, TRACIE LYNN (ATC)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:LYNN
Last Name:BARNES
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 1:3504 VALLEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4237
Mailing Address - Country:US
Mailing Address - Phone:937-510-4428
Mailing Address - Fax:
Practice Address - Street 1:3504 VALLEYWOOD DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4237
Practice Address - Country:US
Practice Address - Phone:937-510-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH45472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer