Provider Demographics
NPI:1114610649
Name:TRACY, MARGARET (DPT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGO
Other - Middle Name:
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:525 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2246
Mailing Address - Country:US
Mailing Address - Phone:650-575-5795
Mailing Address - Fax:
Practice Address - Street 1:16185 LOS GATOS BLVD STE 290
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4568
Practice Address - Country:US
Practice Address - Phone:866-839-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist