Provider Demographics
NPI:1235270166
Name:POWER, TRACEY LYNN (ATC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:POWER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PINE PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5311
Mailing Address - Country:US
Mailing Address - Phone:732-977-9225
Mailing Address - Fax:
Practice Address - Street 1:669 AVENUE A
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1851
Practice Address - Country:US
Practice Address - Phone:201-858-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00097500390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program