Provider Demographics
NPI:1821360629
Name:THOMAS, TRACY ALISHA (PT, PH D)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ALISHA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 KING SOLOMON ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-6825
Mailing Address - Country:US
Mailing Address - Phone:850-519-0393
Mailing Address - Fax:
Practice Address - Street 1:505 KING SOLOMON ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-6825
Practice Address - Country:US
Practice Address - Phone:850-519-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 0011999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist