Provider Demographics
NPI:1295989549
Name:MURRAY, TRACIE DALTON (MSPT)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:DALTON
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MRS
Other - First Name:TRACIE
Other - Middle Name:DALTON
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:279 BROOKLAKE RD
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2222
Mailing Address - Country:US
Mailing Address - Phone:917-881-9975
Mailing Address - Fax:
Practice Address - Street 1:194 2ND AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1141
Practice Address - Country:US
Practice Address - Phone:973-256-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0234942251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics