Provider Demographics
NPI:1710004213
Name:DUCKWORTH, TRACY J (PTA)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:J
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 WILD CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9004
Mailing Address - Country:US
Mailing Address - Phone:803-791-2155
Mailing Address - Fax:
Practice Address - Street 1:324 WILD CHERRY RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9004
Practice Address - Country:US
Practice Address - Phone:803-791-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1327225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant