Provider Demographics
NPI:1700222759
Name:TRACY ALDOUS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:TRACY ALDOUS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:AKINS
Authorized Official - Last Name:ALDOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-433-9255
Mailing Address - Street 1:6932 SPICKARD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5658
Mailing Address - Country:US
Mailing Address - Phone:310-433-9255
Mailing Address - Fax:
Practice Address - Street 1:6932 SPICKARD DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5658
Practice Address - Country:US
Practice Address - Phone:310-433-9255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty