Provider Demographics
NPI:1518050582
Name:TRACY, JAMES EDWARD (PT, DPT,MS,OCS,MTC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:TRACY
Suffix:
Gender:M
Credentials:PT, DPT,MS,OCS,MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CAPE FEAR LOOP
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-1811
Mailing Address - Country:US
Mailing Address - Phone:252-393-8828
Mailing Address - Fax:252-393-7928
Practice Address - Street 1:702 CEDAR POINT BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8012
Practice Address - Country:US
Practice Address - Phone:252-393-8828
Practice Address - Fax:252-393-7928
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1026QOtherBLUE CROSS BLUE SHIELD
NC720785XMedicaid
NC720785XMedicaid