Provider Demographics
NPI:1659848083
Name:RAWLS, TRACYE MICHELE (GFI MS ATC)
Entity Type:Individual
Prefix:
First Name:TRACYE
Middle Name:MICHELE
Last Name:RAWLS
Suffix:
Gender:F
Credentials:GFI MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE UNIVERSITY PLAZA
Mailing Address - Street 2:SHP HS 312
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-780-4081
Mailing Address - Fax:
Practice Address - Street 1:ONE UNIVERSITY PLAZA
Practice Address - Street 2:SHP HS 312
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-780-4081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000874-12081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine