Provider Demographics
NPI:1346914496
Name:BISKE, TRACY (MPT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BISKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WOODSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-7456
Mailing Address - Country:US
Mailing Address - Phone:630-956-4536
Mailing Address - Fax:
Practice Address - Street 1:134 WOODSTONE WAY
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-7456
Practice Address - Country:US
Practice Address - Phone:630-956-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC107972251P0200X
IL070.0150132251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics