Provider Demographics
NPI:1740740224
Name:SCALFARO, TRACY (PT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SCALFARO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-2616
Mailing Address - Country:US
Mailing Address - Phone:567-221-1021
Mailing Address - Fax:567-221-1022
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-2616
Practice Address - Country:US
Practice Address - Phone:567-221-1021
Practice Address - Fax:567-221-1022
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT011803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist