Provider Demographics
NPI:1497390322
Name:DEAL, TRACY LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:DEAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 BIDDLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4691
Mailing Address - Country:US
Mailing Address - Phone:541-734-7000
Mailing Address - Fax:
Practice Address - Street 1:1550 BIDDLE RD STE C
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4691
Practice Address - Country:US
Practice Address - Phone:541-734-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7870225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7870OtherOREGON BOARD OF MASSAGE THERAPY