Provider Demographics
NPI:1821404898
Name:SZABO, TRACEY I
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:SZABO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938B W SHAWNEE ST
Mailing Address - Street 2:938 B SHAWNEE
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-3511
Mailing Address - Country:US
Mailing Address - Phone:918-683-7731
Mailing Address - Fax:717-635-3975
Practice Address - Street 1:938B W SHAWNEE ST
Practice Address - Street 2:938 B SHAWNEE
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3511
Practice Address - Country:US
Practice Address - Phone:918-683-7731
Practice Address - Fax:717-635-3975
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1440225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant