Provider Demographics
NPI:1235408626
Name:KREUTZER, TRACIE JANET (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:JANET
Last Name:KREUTZER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 MALL DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7634
Mailing Address - Country:US
Mailing Address - Phone:715-552-1035
Mailing Address - Fax:
Practice Address - Street 1:3656 MALL DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7634
Practice Address - Country:US
Practice Address - Phone:715-552-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1698-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant