Provider Demographics
NPI:1568817864
Name:BRACEY, VICTOR (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:BRACEY
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 AUBEL RD
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:PA
Mailing Address - Zip Code:17314-8781
Mailing Address - Country:US
Mailing Address - Phone:443-617-8765
Mailing Address - Fax:
Practice Address - Street 1:1445 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2449
Practice Address - Country:US
Practice Address - Phone:443-617-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00005262081S0010X
PARTO0002072081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine