Provider Demographics
NPI:1942619069
Name:FEE, TRACI ALEXA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:ALEXA
Last Name:FEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:TRACI
Other - Middle Name:ALEXA
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10400 READING RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-4816
Mailing Address - Country:US
Mailing Address - Phone:513-733-3370
Mailing Address - Fax:513-786-7893
Practice Address - Street 1:10400 READING RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4816
Practice Address - Country:US
Practice Address - Phone:513-733-3370
Practice Address - Fax:513-786-7893
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH014986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112620Medicaid