Provider Demographics
NPI:1386639201
Name:STONE, TRACY L (LMT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:STONE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 495665
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5665
Mailing Address - Country:US
Mailing Address - Phone:941-575-8228
Mailing Address - Fax:941-575-9743
Practice Address - Street 1:3400 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8102
Practice Address - Country:US
Practice Address - Phone:941-575-8228
Practice Address - Fax:941-575-9743
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37793225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1261Medicare PIN