Provider Demographics
NPI:1558068734
Name:CADORETTE, TRACY BELANA (PTA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:BELANA
Last Name:CADORETTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 SPICEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3234
Mailing Address - Country:US
Mailing Address - Phone:910-670-0725
Mailing Address - Fax:
Practice Address - Street 1:4434 OLD BATTLEGROUND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9828
Practice Address - Country:US
Practice Address - Phone:336-282-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4615225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant