Provider Demographics
NPI:1225083017
Name:VIDEON, TRACY C (PT, ATC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:C
Last Name:VIDEON
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 REDBROOK CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 CONOWINGO RD
Practice Address - Street 2:SUITE C
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-1809
Practice Address - Country:US
Practice Address - Phone:410-420-2257
Practice Address - Fax:410-420-2267
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD468MP430Medicare Oscar/Certification