Provider Demographics
NPI:1437586575
Name:LYNCH, TRACIE SHERRY (PT)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:SHERRY
Last Name:LYNCH
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 1:1125 PINE KNOLLS RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8232
Mailing Address - Country:US
Mailing Address - Phone:336-404-1684
Mailing Address - Fax:336-497-3072
Practice Address - Street 1:1130D SNOW BRIDGE LN
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284
Practice Address - Country:US
Practice Address - Phone:336-904-0467
Practice Address - Fax:336-497-3072
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist