Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT011276L | PA |
NPI | 1003383811 |
---|---|
Provider Name | John Patrick Tracey |
First Address | Meadowbrook, PA 19046-8001 |
Second Address | Meadowbrook, PA 19046-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2018 |
Last Update Date | 30/10/2018 |