Provider Demographics
NPI:1497859029
Name:BATSON, TRACEY DUNCAN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:DUNCAN
Last Name:BATSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 HALL ST
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-2105
Mailing Address - Country:US
Mailing Address - Phone:601-928-5511
Mailing Address - Fax:601-928-6110
Practice Address - Street 1:711 HALL ST
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2105
Practice Address - Country:US
Practice Address - Phone:601-928-5511
Practice Address - Fax:601-928-6110
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123057Medicaid