Provider Demographics
NPI:1811437015
Name:PASCHAL, TRACEY DENIECE (PT, DPT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:DENIECE
Last Name:PASCHAL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 HIGHWAY 34 E
Mailing Address - Street 2:STE 1300
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3186
Mailing Address - Country:US
Mailing Address - Phone:770-502-2175
Mailing Address - Fax:
Practice Address - Street 1:3645 MARKETPLACE BLVD
Practice Address - Street 2:STE 160
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5747
Practice Address - Country:US
Practice Address - Phone:404-344-2823
Practice Address - Fax:404-629-3737
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist