Provider Demographics
NPI:1598920894
Name:BRANDFASS, TRACY LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:BRANDFASS
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 1:487 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3936
Mailing Address - Country:US
Mailing Address - Phone:740-452-0003
Mailing Address - Fax:
Practice Address - Street 1:487 PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3936
Practice Address - Country:US
Practice Address - Phone:740-452-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4495225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant