Provider Demographics
NPI:1518691567
Name:WILLIAMS, TRACY II
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WILLIAMS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18981 E CHAFFEE PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6603
Mailing Address - Country:US
Mailing Address - Phone:303-356-7344
Mailing Address - Fax:
Practice Address - Street 1:11178 HURON ST STE 7
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3343
Practice Address - Country:US
Practice Address - Phone:303-356-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist