Provider Demographics
NPI:1871834317
Name:SUMMES, TRACY DAWN (PTA)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:DAWN
Last Name:SUMMES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 OLIVET CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9618
Mailing Address - Country:US
Mailing Address - Phone:270-444-9661
Mailing Address - Fax:127-043-9407
Practice Address - Street 1:501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-0749
Practice Address - Country:US
Practice Address - Phone:127-044-4966
Practice Address - Fax:270-443-9407
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01423225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant