Provider Demographics
NPI:1558497453
Name:PIENKOS, TRACY L (PT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:PIENKOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:LIFECENTER, 2ND FLOOR
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5549
Mailing Address - Country:US
Mailing Address - Phone:609-677-7268
Mailing Address - Fax:609-677-7269
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:LIFECENTER, 2ND FLOOR
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5549
Practice Address - Country:US
Practice Address - Phone:609-677-7268
Practice Address - Fax:609-677-7269
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01030100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1316362494OtherCHAMPION REHABILITATION LLC GROUP NPI