Provider Demographics
NPI:1770909269
Name:HUPPE, TRACEY
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:HUPPE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TRACEY
Other - Middle Name:ANN
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10 VEAZY CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6643
Mailing Address - Country:US
Mailing Address - Phone:603-679-5844
Mailing Address - Fax:
Practice Address - Street 1:10 VEAZY CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NH
Practice Address - Zip Code:03833-6643
Practice Address - Country:US
Practice Address - Phone:603-818-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-09
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist