Provider Demographics
NPI:1558753038
Name:SHER, TRACY (MPT, CSCS)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SHER
Suffix:
Gender:F
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 S MAITLAND AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5638
Mailing Address - Country:US
Mailing Address - Phone:407-257-1403
Mailing Address - Fax:321-348-5779
Practice Address - Street 1:235 S MAITLAND AVE STE 214
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5638
Practice Address - Country:US
Practice Address - Phone:407-257-1403
Practice Address - Fax:321-348-5779
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist