Provider Demographics
NPI:1740243211
Name:KURTZ, TRACY WALKER (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:WALKER
Last Name:KURTZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OAK GROVE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963
Mailing Address - Country:US
Mailing Address - Phone:570-345-9966
Mailing Address - Fax:570-345-9988
Practice Address - Street 1:8 OAK GROVE RD
Practice Address - Street 2:STE 3
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963
Practice Address - Country:US
Practice Address - Phone:570-345-9966
Practice Address - Fax:570-345-9988
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097272NSHOtherHIGHMARK MEDICARE SERVICES
PA1779411OtherPENNSYLVANIA BLUE SHIELD
PA50054404OtherCAPITAL BLUE CROSS/CAIC
PA50054404OtherCAPITAL ADVANTAGE
PA1779411OtherPENNSYLVANIA BLUE SHIELD