Provider Demographics
NPI:1407570153
Name:NESTLER, TRACIE ANN (LMT,AAS)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:ANN
Last Name:NESTLER
Suffix:
Gender:F
Credentials:LMT,AAS
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:ANN
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT,AAS
Mailing Address - Street 1:244 N MOLLISON AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-6892
Mailing Address - Country:US
Mailing Address - Phone:858-899-1287
Mailing Address - Fax:
Practice Address - Street 1:1571 N MAGNOLIA AVE STE 212
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1274
Practice Address - Country:US
Practice Address - Phone:619-975-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71871225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225700000XOtherMASSAGE THERAPY