Provider Demographics
NPI:1639512718
Name:HAAS, TRACI (PT OCS CSCS)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:PT OCS CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 GERYVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-2306
Mailing Address - Country:US
Mailing Address - Phone:215-862-4195
Mailing Address - Fax:215-679-0722
Practice Address - Street 1:2767 GERYVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-2306
Practice Address - Country:US
Practice Address - Phone:215-862-4195
Practice Address - Fax:215-679-0722
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010671L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist