Provider Demographics
NPI:1851740849
Name:MECHENBIER, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MECHENBIER
Suffix:
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 1:6400 JEFFERSON ST NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3470
Mailing Address - Country:US
Mailing Address - Phone:505-344-2922
Mailing Address - Fax:505-214-5030
Practice Address - Street 1:6400 JEFFERSON ST NE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3470
Practice Address - Country:US
Practice Address - Phone:505-344-2922
Practice Address - Fax:505-214-5030
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist