Provider Demographics
NPI:1477206530
Name:ROSS, TRACI S (PT)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:S
Last Name:ROSS
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:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:LIPAN
Mailing Address - State:TX
Mailing Address - Zip Code:76462-0119
Mailing Address - Country:US
Mailing Address - Phone:325-716-9443
Mailing Address - Fax:
Practice Address - Street 1:215 W LIPAN DR
Practice Address - Street 2:
Practice Address - City:LIPAN
Practice Address - State:TX
Practice Address - Zip Code:76462-2001
Practice Address - Country:US
Practice Address - Phone:325-716-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11317952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic