Provider Demographics
NPI:1821465303
Name:TRACZ, KRISTIN (DPT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:TRACZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 BLACKHAWK DR SW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-2045
Mailing Address - Country:US
Mailing Address - Phone:608-358-2182
Mailing Address - Fax:
Practice Address - Street 1:1555 SHERWOOD ST SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3285
Practice Address - Country:US
Practice Address - Phone:320-484-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9595225100000X
WI1216424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist