Provider Demographics
NPI:1710348842
Name:MAGLY, TRACY (LMT)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:MAGLY
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 1:3278 SERVIA ELMIRA RD
Mailing Address - Street 2:
Mailing Address - City:DUCK
Mailing Address - State:WV
Mailing Address - Zip Code:25063-5005
Mailing Address - Country:US
Mailing Address - Phone:304-364-5020
Mailing Address - Fax:304-364-5020
Practice Address - Street 1:3278 SERVIA ELMIRA RD
Practice Address - Street 2:
Practice Address - City:DUCK
Practice Address - State:WV
Practice Address - Zip Code:25063-5005
Practice Address - Country:US
Practice Address - Phone:304-364-5020
Practice Address - Fax:304-364-5020
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2015-3328225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist