Provider Demographics
NPI:1811189376
Name:ARTZ, TRACY L (PTA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:ARTZ
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:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:SD
Mailing Address - Zip Code:57451-0728
Mailing Address - Country:US
Mailing Address - Phone:605-426-6622
Mailing Address - Fax:
Practice Address - Street 1:617 BLOEMENDAAL DR
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:SD
Practice Address - Zip Code:57451-2019
Practice Address - Country:US
Practice Address - Phone:605-426-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0217225200000X
WYPTA-195225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant