Provider Demographics
NPI:1245013069
Name:MELDRUM, TRACY G (LMT)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:G
Last Name:MELDRUM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:MELDRUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2348 KIESEL AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1964
Mailing Address - Country:US
Mailing Address - Phone:801-528-5066
Mailing Address - Fax:801-528-5067
Practice Address - Street 1:2348 KIESEL AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1964
Practice Address - Country:US
Practice Address - Phone:801-528-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8024531-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist