Provider Demographics
NPI:1013970961
Name:SARABIA, TRACI LYNN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:LYNN
Last Name:SARABIA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:WERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-5635
Mailing Address - Country:US
Mailing Address - Phone:518-954-2027
Mailing Address - Fax:518-842-3507
Practice Address - Street 1:43 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-5635
Practice Address - Country:US
Practice Address - Phone:518-954-2027
Practice Address - Fax:518-842-3507
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0185271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02430624Medicaid
10074339OtherCDPHP
000407231005OtherBLUE SHIELD
394901OtherMVP
QS9453OtherBLUE CROSS
000407231005OtherBLUE SHIELD
P90944Medicare UPIN