Provider Demographics
NPI:1437257862
Name:EISENBEIS, TRACY ESTELLE (PT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ESTELLE
Last Name:EISENBEIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 KINGS PARADE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5608
Mailing Address - Country:US
Mailing Address - Phone:704-692-1087
Mailing Address - Fax:
Practice Address - Street 1:10009 PARK CEDAR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8920
Practice Address - Country:US
Practice Address - Phone:704-716-1024
Practice Address - Fax:704-716-1025
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist