Provider Demographics
NPI:1366470478
Name:STUBBINS, TRACY A (MSPT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:STUBBINS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KENNEDY LN
Mailing Address - Street 2:
Mailing Address - City:W YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-2745
Mailing Address - Country:US
Mailing Address - Phone:508-394-3244
Mailing Address - Fax:
Practice Address - Street 1:130 NORTH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3825
Practice Address - Country:US
Practice Address - Phone:508-771-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist