Provider Demographics
NPI:1376694638
Name:BOUY, TRACY L (DPT, MTC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:BOUY
Suffix:
Gender:F
Credentials:DPT, MTC
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:HEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, MTC
Mailing Address - Street 1:24 OAKTHORN CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5464
Mailing Address - Country:US
Mailing Address - Phone:337-517-1040
Mailing Address - Fax:337-856-6576
Practice Address - Street 1:24 OAKTHORN CT
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5464
Practice Address - Country:US
Practice Address - Phone:337-517-1040
Practice Address - Fax:337-856-6576
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06880R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4K059CT74Medicare PIN