Provider Demographics
NPI:1649486531
Name:TRACZEK, CYNTHIA LENORE (PTA)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LENORE
Last Name:TRACZEK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1407
Mailing Address - Country:US
Mailing Address - Phone:414-507-5485
Mailing Address - Fax:
Practice Address - Street 1:3601 S CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-3708
Practice Address - Country:US
Practice Address - Phone:414-764-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI440-019314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility