Provider Demographics
NPI:1851524458
Name:RUESCHHOFF, TRACEY L (CPO/LPO)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:RUESCHHOFF
Suffix:
Gender:F
Credentials:CPO/LPO
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:L
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPO/LPO
Mailing Address - Street 1:7777 FOREST LN BLDG C
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-4999
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN BLDG C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist