Provider Demographics
NPI:1851401475
Name:CARLSON, TRACI MARIE (PT)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:MARIE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:TRACI
Other - Middle Name:MARIE
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1709 REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1844
Mailing Address - Country:US
Mailing Address - Phone:301-261-3999
Mailing Address - Fax:
Practice Address - Street 1:901 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2944
Practice Address - Country:US
Practice Address - Phone:410-224-2626
Practice Address - Fax:410-224-0512
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist