Provider Demographics
NPI:1750685079
Name:ABBOTT, TRACI M (DC, PT)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:M
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 E 6TH ST
Mailing Address - Street 2:600
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4095
Mailing Address - Country:US
Mailing Address - Phone:903-816-2703
Mailing Address - Fax:
Practice Address - Street 1:1211 E 6TH ST
Practice Address - Street 2:600
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4095
Practice Address - Country:US
Practice Address - Phone:903-816-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility