Provider Demographics
NPI:1467467878
Name:DOYLE, TRACY MARIE (PT, CHT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MARIE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4184 SENECA ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3051
Mailing Address - Country:US
Mailing Address - Phone:716-677-2027
Mailing Address - Fax:716-677-2027
Practice Address - Street 1:4184 SENECA ST
Practice Address - Street 2:SUITE 211
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3051
Practice Address - Country:US
Practice Address - Phone:716-677-2027
Practice Address - Fax:716-677-2027
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0078432251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000069789OtherGHI
NY006061255OtherBC/BS OF WNY
NY112504100OtherFEDERAL WCB
NY00010234801OtherEXCELLUS/UNIVERA
NY9351841OtherINDEPENDENT HEALTH
NY00010234801OtherEXCELLUS/UNIVERA
NY006061255OtherBC/BS OF WNY