Provider Demographics
NPI:1861644577
Name:TRACY, KATHARINE L (DPT)
Entity Type:Individual
Prefix:MISS
First Name:KATHARINE
Middle Name:L
Last Name:TRACY
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 1:3059 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13416-3703
Mailing Address - Country:US
Mailing Address - Phone:315-868-5655
Mailing Address - Fax:
Practice Address - Street 1:4290 MIDDLE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5314
Practice Address - Country:US
Practice Address - Phone:315-797-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030525-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist