Provider Demographics
NPI:1679807325
Name:ROBB, TRACI ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:ANN
Last Name:ROBB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W HALSELL ST
Mailing Address - Street 2:
Mailing Address - City:DIMMITT
Mailing Address - State:TX
Mailing Address - Zip Code:79027-1846
Mailing Address - Country:US
Mailing Address - Phone:806-647-5646
Mailing Address - Fax:806-647-3857
Practice Address - Street 1:310 W HALSELL ST
Practice Address - Street 2:
Practice Address - City:DIMMITT
Practice Address - State:TX
Practice Address - Zip Code:79027-1846
Practice Address - Country:US
Practice Address - Phone:806-647-5646
Practice Address - Fax:806-647-3857
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1085736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist