Provider Demographics
NPI:1508078486
Name:MENGES, TRACYE N (MS, ATC)
Entity Type:Individual
Prefix:
First Name:TRACYE
Middle Name:N
Last Name:MENGES
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1561
Mailing Address - Country:US
Mailing Address - Phone:440-204-1136
Mailing Address - Fax:
Practice Address - Street 1:5800 COOPER FOSTER PARK RD W
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4131
Practice Address - Country:US
Practice Address - Phone:440-204-7800
Practice Address - Fax:440-204-7855
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0013372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer