Provider Demographics
NPI:1053115956
Name:INGALLS, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:INGALLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7887 N LA CHOLLA BLVD APT 1183
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4354
Mailing Address - Country:US
Mailing Address - Phone:512-299-0575
Mailing Address - Fax:
Practice Address - Street 1:7887 N LA CHOLLA BLVD APT 1183
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4354
Practice Address - Country:US
Practice Address - Phone:512-299-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist