Provider Demographics
NPI:1023070919
Name:MCCLOSKEY, TRACI (PT)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60037
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-0037
Mailing Address - Country:US
Mailing Address - Phone:361-949-9898
Mailing Address - Fax:361-949-9897
Practice Address - Street 1:14302 NEMO COURT
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418
Practice Address - Country:US
Practice Address - Phone:361-949-9898
Practice Address - Fax:361-949-9897
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10810703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3996OtherBCBS
TX176267601Medicaid
TX176267601Medicaid