Provider Demographics
NPI:1124184809
Name:WILLIAMS, TRACY LYNN (PT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 TSCHAPPLER RD
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-2323
Mailing Address - Country:US
Mailing Address - Phone:573-437-6181
Mailing Address - Fax:
Practice Address - Street 1:509 W. 18TH ST.
Practice Address - Street 2:
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041-0470
Practice Address - Country:US
Practice Address - Phone:573-486-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist