Provider Demographics
NPI:1891058053
Name:URBAIN, TRACY LEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:URBAIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:14802 SHAMROCK WAY STE C
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-8381
Practice Address - Country:US
Practice Address - Phone:816-873-1101
Practice Address - Fax:816-399-5796
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014329225100000X
MO2021029302225100000X
KS1106823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69750045Medicare PIN
MIMI6211061Medicare PIN