Provider Demographics
NPI:1326382383
Name:SEDLACEK, TRACEY LEE (CMP-T, MMT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEE
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:CMP-T, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 HASTINGS ST
Mailing Address - Street 2:BOX 1
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3454
Mailing Address - Country:US
Mailing Address - Phone:231-935-4325
Mailing Address - Fax:
Practice Address - Street 1:806 HASTINGS ST
Practice Address - Street 2:STE. N
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3454
Practice Address - Country:US
Practice Address - Phone:231-935-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist