Provider Demographics
NPI:1205032380
Name:SCHIPPANI, TRACEY JENINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:JENINE
Last Name:SCHIPPANI
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 1:241 WOODTICK RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2757
Mailing Address - Country:US
Mailing Address - Phone:203-879-6060
Mailing Address - Fax:
Practice Address - Street 1:444 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2639
Practice Address - Country:US
Practice Address - Phone:203-879-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist