Provider Demographics
NPI:1922723444
Name:KROENING, TRACY EILEEN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:EILEEN
Last Name:KROENING
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 1:110 W WOODSTOCK ST STE A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4239
Mailing Address - Country:US
Mailing Address - Phone:815-893-9075
Mailing Address - Fax:844-462-9452
Practice Address - Street 1:110 W WOODSTOCK ST STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4239
Practice Address - Country:US
Practice Address - Phone:815-893-9075
Practice Address - Fax:844-462-9452
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1600007965225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant