Provider Demographics
NPI:1366640922
Name:DUFFIELD, TRACI LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:DUFFIELD
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 1:383 HUDSONDALE ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18255-1308
Mailing Address - Country:US
Mailing Address - Phone:570-427-5073
Mailing Address - Fax:
Practice Address - Street 1:1000 W 27TH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-9604
Practice Address - Country:US
Practice Address - Phone:570-454-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEOOO169L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant