Provider Demographics
NPI:1982627709
Name:CARROLL, TRACY (PT, CHT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 N ROSEMONT BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6114
Mailing Address - Country:US
Mailing Address - Phone:520-232-9797
Mailing Address - Fax:
Practice Address - Street 1:2312 N ROSEMONT BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6114
Practice Address - Country:US
Practice Address - Phone:520-232-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1483225100000X
AZ92090014182251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand