Provider Demographics
NPI:1942228218
Name:BROWN, TRACY HAMPTON (PT, DPT, CIMT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:HAMPTON
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT, CIMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 WISTAR RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-4007
Mailing Address - Country:US
Mailing Address - Phone:215-808-2653
Mailing Address - Fax:215-943-0861
Practice Address - Street 1:173 WISTAR RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-4007
Practice Address - Country:US
Practice Address - Phone:215-808-2653
Practice Address - Fax:215-943-0861
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist