Provider Demographics
NPI:1932224979
Name:BOONE, TRACY LIN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LIN
Last Name:BOONE
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 1:818 MASSACHUSETTS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1704
Mailing Address - Country:US
Mailing Address - Phone:513-943-9624
Mailing Address - Fax:513-943-9624
Practice Address - Street 1:431 OHIO PIKE
Practice Address - Street 2:SUITE 108
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3375
Practice Address - Country:US
Practice Address - Phone:513-528-3100
Practice Address - Fax:513-528-3533
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2627161Medicaid
OHBO4151821Medicare ID - Type Unspecified
OHBO4151822Medicare ID - Type Unspecified