Provider Demographics
NPI:1336331701
Name:DRACE, NANCY DENISE (PTA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DENISE
Last Name:DRACE
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 1:5 CYPRESS CRK
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9747
Mailing Address - Country:US
Mailing Address - Phone:901-496-3189
Mailing Address - Fax:
Practice Address - Street 1:661 HIGHWAY 64B
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-8506
Practice Address - Country:US
Practice Address - Phone:870-208-9572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1806225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant