Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1483 | AZ |
N | 2251H1200X | Hand | 9209001418 | AZ |
NPI | 1982627709 |
---|---|
Provider Name | Tracy Carroll |
First Address | Tucson, AZ 85712-6114 |
Second Address | Tucson, AZ 85712-6114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |