Provider Demographics
NPI:1740301944
Name:STREETT, TRACEY LEIGH (PT)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LEIGH
Last Name:STREETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7802
Mailing Address - Country:US
Mailing Address - Phone:410-635-3553
Mailing Address - Fax:
Practice Address - Street 1:700 TOLL HOUSE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4575
Practice Address - Country:US
Practice Address - Phone:301-663-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist