Provider Demographics
NPI:1669516894
Name:GIRARD, TRACY (MSPT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:GIRARD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:GUILLILY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:37 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-2562
Mailing Address - Country:US
Mailing Address - Phone:518-563-8035
Mailing Address - Fax:
Practice Address - Street 1:75 BEEKMAN ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1438
Practice Address - Country:US
Practice Address - Phone:518-562-7900
Practice Address - Fax:518-562-7933
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00318814Medicaid
NY000490084001OtherBSNENY
NY141338471OtherACN
NY330250Medicare ID - Type Unspecified