Provider Demographics
NPI:1326165317
Name:FLEWELLING, TRACEY ELIZABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ELIZABETH
Last Name:FLEWELLING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:ELIZABETH
Other - Last Name:BERNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:97 WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:UNITY
Mailing Address - State:ME
Mailing Address - Zip Code:04988-3929
Mailing Address - Country:US
Mailing Address - Phone:207-948-3037
Mailing Address - Fax:
Practice Address - Street 1:117 BENNOCH RD
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3620
Practice Address - Country:US
Practice Address - Phone:207-866-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1618225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant