Provider Demographics
NPI:1710255948
Name:BEATTIE, TRACY ANN (RPT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:34 PEARLY LN
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1736
Mailing Address - Country:US
Mailing Address - Phone:978-632-1230
Mailing Address - Fax:978-632-4513
Practice Address - Street 1:34 PEARLY LN
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1736
Practice Address - Country:US
Practice Address - Phone:978-632-1230
Practice Address - Fax:978-632-4513
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist