Provider Demographics
NPI:1831457423
Name:DOUGHTY-ROSAS, TRACY M (CMT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:M
Last Name:DOUGHTY-ROSAS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1828
Mailing Address - Country:US
Mailing Address - Phone:218-740-2777
Mailing Address - Fax:218-740-2778
Practice Address - Street 1:1705 MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1828
Practice Address - Country:US
Practice Address - Phone:218-740-2777
Practice Address - Fax:218-740-2778
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist