Provider Demographics
NPI:1619107943
Name:MOODY CESSNA, TRACY LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:MOODY CESSNA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6350 GLENWAY AVE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6378
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-347-3999
Practice Address - Street 1:6350 GLENWAY AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6378
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-347-3999
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.0131932251X0800X
PAPT0195552251G0304X
KYPT0054602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK019820Medicare PIN
OHH026412Medicare PIN