Provider Demographics
NPI:1356558084
Name:DANIELAK, TRACY ANN (MSPT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:DANIELAK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:MIX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 CEDAR RUN RD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-3504
Mailing Address - Country:US
Mailing Address - Phone:732-606-0526
Mailing Address - Fax:
Practice Address - Street 1:340 ATLANTIC CITY BLVD
Practice Address - Street 2:340 ROUTE 9 PENN FEDERAL PLAZA
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1255
Practice Address - Country:US
Practice Address - Phone:973-361-5500
Practice Address - Fax:973-361-5080
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist