Provider Demographics
NPI:1811487812
Name:BYRNE, TRACEY L (PT)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:L
Last Name:BYRNE
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 1:1350 RT 23N
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5892
Mailing Address - Country:US
Mailing Address - Phone:973-709-9200
Mailing Address - Fax:973-709-9207
Practice Address - Street 1:1350 STATE ROUTE 23
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07471
Practice Address - Country:US
Practice Address - Phone:973-709-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist