Provider Demographics
NPI:1477621860
Name:SAUNDERS, TRACY GEORGE (ATC)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:GEORGE
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JOPLIN HIGH SCHOOL
Mailing Address - Street 2:2104 INDIANA AVE.
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-625-5230
Mailing Address - Fax:417-625-5238
Practice Address - Street 1:JOPLIN HIGH SCHOOL
Practice Address - Street 2:2104 INDIANA AVE.
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-625-5230
Practice Address - Fax:417-625-5238
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer