Provider Demographics
NPI:1275578536
Name:HUIE, TRACEY LYN (MS, ATC/LAT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LYN
Last Name:HUIE
Suffix:
Gender:F
Credentials:MS, ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 RIVERHILL CT NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1954
Mailing Address - Country:US
Mailing Address - Phone:770-552-0024
Mailing Address - Fax:
Practice Address - Street 1:4175 RIVERHILL CT NE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1954
Practice Address - Country:US
Practice Address - Phone:770-552-0024
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0008772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer