Provider Demographics
NPI:1417313297
Name:COVASSIN, TRACEY (PHD, ATC, FNATA)
Entity Type:Individual
Prefix:PROF
First Name:TRACEY
Middle Name:
Last Name:COVASSIN
Suffix:
Gender:F
Credentials:PHD, ATC, FNATA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W CIRCLE DRIVE
Mailing Address - Street 2:DEPARTMENT OF KINESIOLOGY, MICHIGAN STATE UNIVERSITY
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824
Mailing Address - Country:US
Mailing Address - Phone:517-353-2010
Mailing Address - Fax:
Practice Address - Street 1:308 W CIRCLE DR
Practice Address - Street 2:DEPARTMENT OF KINEISOLOGY MICHIGAN STATE UNIVERSITY
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-3700
Practice Address - Country:US
Practice Address - Phone:517-353-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010006082255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer