Provider Demographics
NPI:1144528803
Name:DILLON, TRACY L (PT)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:DILLON
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 1:101 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2318
Mailing Address - Country:US
Mailing Address - Phone:731-431-0610
Mailing Address - Fax:731-300-3374
Practice Address - Street 1:101 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2318
Practice Address - Country:US
Practice Address - Phone:731-431-0610
Practice Address - Fax:731-300-3374
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000004019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist