Provider Demographics
NPI:1245547546
Name:DOYLE, TRACEY ROSE
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ROSE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:ROSE
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3629
Mailing Address - Country:US
Mailing Address - Phone:201-251-2422
Mailing Address - Fax:
Practice Address - Street 1:1 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3629
Practice Address - Country:US
Practice Address - Phone:201-251-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA12403002251X0800X
NY0188492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic