Provider Demographics
NPI:1518995281
Name:ZYTKOSKEE, TRACY D (PT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:D
Last Name:ZYTKOSKEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5851
Mailing Address - Country:US
Mailing Address - Phone:318-746-5295
Mailing Address - Fax:318-746-5297
Practice Address - Street 1:2906 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5851
Practice Address - Country:US
Practice Address - Phone:318-746-5295
Practice Address - Fax:318-746-5297
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00303R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56479C698Medicare PIN