Provider Demographics
NPI:1881903730
Name:CAHAK, TRACEE BLACKLOCK (PT)
Entity type:Individual
Prefix:MRS
First Name:TRACEE
Middle Name:BLACKLOCK
Last Name:CAHAK
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 1:621 S RUIDOSA DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-7254
Mailing Address - Country:US
Mailing Address - Phone:254-662-3767
Mailing Address - Fax:
Practice Address - Street 1:1700 WOODGATE DR
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-8600
Practice Address - Country:US
Practice Address - Phone:254-666-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10512822251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics