Provider Demographics
NPI:1932520913
Name:NIX, TRACEY (LPO)
Entity Type:Individual
Prefix:MISS
First Name:TRACEY
Middle Name:
Last Name:NIX
Suffix:
Gender:F
Credentials:LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15301 SPECTRUM DR
Mailing Address - Street 2:SUITE #175
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4665
Mailing Address - Country:US
Mailing Address - Phone:972-980-9660
Mailing Address - Fax:972-980-9313
Practice Address - Street 1:15301 SPECTRUM DR
Practice Address - Street 2:SUITE #175
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4665
Practice Address - Country:US
Practice Address - Phone:972-980-9660
Practice Address - Fax:972-980-9313
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1235222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist