Provider Demographics
NPI:1467219667
Name:CURLEY, TRACI RAENE (ATS)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:RAENE
Last Name:CURLEY
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:GRAND CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:86023-0575
Mailing Address - Country:US
Mailing Address - Phone:928-856-2357
Mailing Address - Fax:
Practice Address - Street 1:5428 SUBLIME DRIVE
Practice Address - Street 2:
Practice Address - City:GRAND CANYON
Practice Address - State:AZ
Practice Address - Zip Code:86023
Practice Address - Country:US
Practice Address - Phone:928-856-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer