Provider Demographics
NPI:1700115318
Name:CLINE, TRACIE MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:MICHELLE
Last Name:CLINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:MICHELLE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8200 HOMER DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8200 HOMER DR
Practice Address - Street 2:SUITE F
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3330
Practice Address - Country:US
Practice Address - Phone:907-345-0050
Practice Address - Fax:907-344-5103
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK21172251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics