Provider Demographics
NPI:1609286681
Name:ZERVOS, TRACY (PT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ZERVOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:VISITING NURSE ASSN MC 480 SPECTRUM HEALTH
Mailing Address - Street 2:100 MICHIGAN ST NE
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:231-355-5300
Mailing Address - Fax:231-355-5325
Practice Address - Street 1:1 STATE RD
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-7981
Practice Address - Country:US
Practice Address - Phone:231-355-5300
Practice Address - Fax:231-355-5325
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501012308OtherPT STATE LICENSE
MI0N79320Medicare PIN