Provider Demographics
NPI:1013913706
Name:BECK, TRACY JEAN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:JEAN
Last Name:BECK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 WESTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1828
Mailing Address - Country:US
Mailing Address - Phone:313-822-2111
Mailing Address - Fax:
Practice Address - Street 1:868 WESTCHESTER RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1828
Practice Address - Country:US
Practice Address - Phone:313-822-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06398R225100000X
MI5501013379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF9746OtherBLUE CROSS BLUE SHIELD
LAF9746OtherBLUE CROSS BLUE SHIELD