Provider Demographics
NPI:1811161177
Name:GRIFFITH, TRACY ANN (PTA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:OATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:FL
Mailing Address - Zip Code:32732-9131
Mailing Address - Country:US
Mailing Address - Phone:321-217-3377
Mailing Address - Fax:
Practice Address - Street 1:1337 S. INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 1321
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32771-1013
Practice Address - Country:US
Practice Address - Phone:407-833-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 21177225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant