Provider Demographics
NPI:1629447214
Name:EWING, TRACEY (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10566
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5010
Mailing Address - Country:US
Mailing Address - Phone:434-799-7732
Mailing Address - Fax:434-799-7733
Practice Address - Street 1:625 PINEY FOREST RD STE 407
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2870
Practice Address - Country:US
Practice Address - Phone:434-799-7732
Practice Address - Fax:434-799-7733
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050062422251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics