Provider Demographics
NPI:1659522860
Name:CECCO, TRACI LENIG (PTA)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LENIG
Last Name:CECCO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2693 LOWER RD
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-7717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 COURT ST
Practice Address - Street 2:CIRCL DRIVE
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2818
Practice Address - Country:US
Practice Address - Phone:570-286-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000148225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant