Provider Demographics
NPI:1013175405
Name:HEPKER, TRACI ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:ANN
Last Name:HEPKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 SW 19TH
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315
Mailing Address - Country:US
Mailing Address - Phone:515-285-2559
Mailing Address - Fax:515-256-4155
Practice Address - Street 1:4911 SW 19TH
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315
Practice Address - Country:US
Practice Address - Phone:515-285-2559
Practice Address - Fax:515-256-4155
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00506225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant