Provider Demographics
NPI:1679594451
Name:LEGRAND, TRACEY ANN (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ANN
Last Name:LEGRAND
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 ALYSHEBA WAY
Mailing Address - Street 2:SUITE 5102
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2280
Mailing Address - Country:US
Mailing Address - Phone:859-543-0319
Mailing Address - Fax:
Practice Address - Street 1:1795 ALYSHEBA WAY
Practice Address - Street 2:SUITE 5102
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2280
Practice Address - Country:US
Practice Address - Phone:859-543-0319
Practice Address - Fax:859-543-2895
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0798504Medicare PIN