Provider Demographics
NPI:1639472293
Name:BRUBAKER, TRACI MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:MARIE
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MABEN RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17094-8587
Mailing Address - Country:US
Mailing Address - Phone:717-535-9904
Mailing Address - Fax:
Practice Address - Street 1:2 MANOR BLVD
Practice Address - Street 2:
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059-8757
Practice Address - Country:US
Practice Address - Phone:717-436-2178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009657L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist