Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT009737 | PA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT009737 | PA |
NPI | 1093903858 |
---|---|
Provider Name | Julianna Tracey |
First Address | Coraopolis, PA 15108-3954 |
Second Address | Coraopolis, PA 15108-3954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2007 |
Last Update Date | 05/10/2007 |