Provider Demographics
NPI:1407101306
Name:REED, TRACY LEAVELLE (DPT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEAVELLE
Last Name:REED
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:D
Other - Last Name:LEAVELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:199 N BROOKMOORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2024
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:1781B COMMONS NORTH LOOP
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-3577
Practice Address - Country:US
Practice Address - Phone:205-752-0845
Practice Address - Fax:205-752-0866
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1003819608OtherGROUP NPI
AL529917620Medicaid
AL529917620Medicaid