Provider Demographics
NPI:1164529335
Name:RAGAN, TRACY A (PTA/L)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:RAGAN
Suffix:
Gender:F
Credentials:PTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 WEST RD
Mailing Address - Street 2:
Mailing Address - City:ASHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01330-9723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:467 WEST RD
Practice Address - Street 2:
Practice Address - City:ASHFIELD
Practice Address - State:MA
Practice Address - Zip Code:01330-9723
Practice Address - Country:US
Practice Address - Phone:413-628-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3587225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant