Provider Demographics
NPI:1700989506
Name:GEMPERLE, TRACEY (MSPT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:GEMPERLE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 MESA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2111
Mailing Address - Country:US
Mailing Address - Phone:512-418-8767
Mailing Address - Fax:512-708-8131
Practice Address - Street 1:9737 GREAT HILLS TRL
Practice Address - Street 2:#240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6417
Practice Address - Country:US
Practice Address - Phone:512-708-8834
Practice Address - Fax:512-708-8131
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist