Provider Demographics
NPI:1760148308
Name:SILICH, TRACIE S (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:S
Last Name:SILICH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 EST GOLDEN ROCK
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VIRGIN ISLANDS
Mailing Address - Zip Code:00820
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201(201-202) ESTATE RUBY
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-6530
Practice Address - Fax:340-778-4922
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI004225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant