Provider Demographics
NPI:1811148968
Name:PHILLIPS, TRACEY A (PT)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:A
Last Name:PHILLIPS
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 1:162 CARPIN LN
Mailing Address - Street 2:
Mailing Address - City:WEEDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15868-2916
Mailing Address - Country:US
Mailing Address - Phone:814-787-4692
Mailing Address - Fax:
Practice Address - Street 1:162 CARPIN LN
Practice Address - Street 2:
Practice Address - City:WEEDVILLE
Practice Address - State:PA
Practice Address - Zip Code:15868-2916
Practice Address - Country:US
Practice Address - Phone:814-787-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007423L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist