Provider Demographics
NPI:1497179485
Name:AMES, TRACY (PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:AMES
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 DEER RUN CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-7535
Mailing Address - Country:US
Mailing Address - Phone:937-383-3249
Mailing Address - Fax:
Practice Address - Street 1:5350 W NEW MARKET RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7722
Practice Address - Country:US
Practice Address - Phone:937-393-1904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist