Provider Demographics
NPI:1811595242
Name:WEHRMAN, TRACY (EPC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:
Last Name:WEHRMAN
Suffix:
Gender:M
Credentials:EPC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 E QUAIL CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-8373
Mailing Address - Country:US
Mailing Address - Phone:316-393-2176
Mailing Address - Fax:
Practice Address - Street 1:7015 E CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1943
Practice Address - Country:US
Practice Address - Phone:316-393-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
307224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist