Provider Demographics
NPI:1750650529
Name:TRACY, KERSTIN S (MS, LMT)
Entity Type:Individual
Prefix:
First Name:KERSTIN
Middle Name:S
Last Name:TRACY
Suffix:
Gender:F
Credentials:MS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 JACK HAMMER DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6135 LAKESIDE DR
Practice Address - Street 2:SUITE 119
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-8504
Practice Address - Country:US
Practice Address - Phone:775-400-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5312225700000X
FL30359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist