Provider Demographics
NPI:1114986262
Name:FLECK, TRACEY MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:MARIE
Last Name:FLECK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 WHITMORE LAKE RD
Mailing Address - Street 2:STE 900
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116
Mailing Address - Country:US
Mailing Address - Phone:810-220-5793
Mailing Address - Fax:810-220-5805
Practice Address - Street 1:5757 WHITMORE LAKE RD
Practice Address - Street 2:STE 900
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116
Practice Address - Country:US
Practice Address - Phone:810-220-5793
Practice Address - Fax:810-220-5805
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist