Provider Demographics
NPI:1679213300
Name:BUSBY, TRACEY L (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:L
Last Name:BUSBY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 COYT GILBERT DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-8009
Mailing Address - Country:US
Mailing Address - Phone:601-740-0694
Mailing Address - Fax:
Practice Address - Street 1:40 COYT GILBERT DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-8009
Practice Address - Country:US
Practice Address - Phone:601-740-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty