Provider Demographics
NPI:1689430274
Name:SLAUGHTER, TRACY DAWN (MSPT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:DAWN
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 BLUE FLAX PT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3467
Mailing Address - Country:US
Mailing Address - Phone:407-782-7849
Mailing Address - Fax:
Practice Address - Street 1:398 FREEMAN ST
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4171
Practice Address - Country:US
Practice Address - Phone:407-682-3600
Practice Address - Fax:407-682-7400
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist