Provider Demographics
NPI:1982956090
Name:PHELPS, TRACEY C (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:C
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SOUTH HUGHES BLVD SUITE B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-335-2087
Mailing Address - Fax:252-335-2682
Practice Address - Street 1:615 S HUGHES BLVD STE B
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4784
Practice Address - Country:US
Practice Address - Phone:252-335-2087
Practice Address - Fax:252-335-2682
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic