Provider Demographics
NPI:1275599409
Name:TRACY HORTER PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:TRACY HORTER PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HORTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-527-0178
Mailing Address - Street 1:919 CONESTOGA RD
Mailing Address - Street 2:BLDG 3 STE 114
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-527-0178
Mailing Address - Fax:610-527-5770
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BLDG 3 STE 114
Practice Address - City:ROSEMONT
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-527-0178
Practice Address - Fax:610-527-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002487L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3721810OtherAETNA HMO
PA2175416000OtherBC PERSONAL CHOICE KEYSTO
PA4338299OtherAETNA PPO
PA118923800OtherUS DEPT OF LABOR
PA1478828OtherHIGHMARK BS
PA040004N9WMedicare ID - Type Unspecified