Provider Demographics
NPI:1952849853
Name:LENOIR, TRACY LYNN (LAT,ATC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:LENOIR
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:EWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT,ATC
Mailing Address - Street 1:718 PARDEE ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-1420
Mailing Address - Country:US
Mailing Address - Phone:610-250-2460
Mailing Address - Fax:
Practice Address - Street 1:1010 ECHO TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-1020
Practice Address - Country:US
Practice Address - Phone:610-250-2460
Practice Address - Fax:610-250-2613
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0041872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer