Provider Demographics
NPI:1245353572
Name:FRENCH, TRACY JO (PT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:JO
Last Name:FRENCH
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 1:13 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1821
Mailing Address - Country:US
Mailing Address - Phone:315-265-0017
Mailing Address - Fax:
Practice Address - Street 1:50 LEROY ST.
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2148
Practice Address - Country:US
Practice Address - Phone:315-261-5460
Practice Address - Fax:315-261-6460
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015711-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist