Provider Demographics
NPI:1710180849
Name:HOGELAND, TRACY ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:HOGELAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NEEDLE BLVD
Mailing Address - Street 2:UNIT 84
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3316
Mailing Address - Country:US
Mailing Address - Phone:321-698-8815
Mailing Address - Fax:
Practice Address - Street 1:55 NEEDLE BLVD
Practice Address - Street 2:UNIT 84
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3316
Practice Address - Country:US
Practice Address - Phone:321-698-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist