Provider Demographics
NPI:1922555747
Name:HARDIN, TRACIE (REEGT)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:REEGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MONTICELLO AVE
Mailing Address - Street 2:210
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3442
Mailing Address - Country:US
Mailing Address - Phone:214-269-3875
Mailing Address - Fax:903-328-6568
Practice Address - Street 1:3100 MONTICELLO AVE
Practice Address - Street 2:210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3442
Practice Address - Country:US
Practice Address - Phone:214-269-3875
Practice Address - Fax:903-328-6568
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic