Provider Demographics
NPI:1366858037
Name:ARIELLE, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ARIELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17752 SKY PARK CIR
Mailing Address - Street 2:230
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6419
Mailing Address - Country:US
Mailing Address - Phone:949-885-0300
Mailing Address - Fax:
Practice Address - Street 1:17752 SKY PARK CIR
Practice Address - Street 2:230
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6419
Practice Address - Country:US
Practice Address - Phone:949-885-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist