Provider Demographics
NPI:1225811698
Name:NUZZI, TRACEY LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LYNN
Last Name:NUZZI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:TRACEY
Other - Middle Name:LYNN
Other - Last Name:ECKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AK
Mailing Address - Zip Code:99574-0396
Mailing Address - Country:US
Mailing Address - Phone:907-331-7128
Mailing Address - Fax:
Practice Address - Street 1:614 FIRST STREET
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574-1174
Practice Address - Country:US
Practice Address - Phone:907-424-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK204265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist