Provider Demographics
NPI:1982845244
Name:LYMAN, TRACY
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:LYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SOUTHERN PINES DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1807
Mailing Address - Country:US
Mailing Address - Phone:607-341-6096
Mailing Address - Fax:
Practice Address - Street 1:1004 SOUTHERN PINES DR
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1807
Practice Address - Country:US
Practice Address - Phone:607-341-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist