1376623363

Everything you always wanted to know about MRS. ERVIN TRACY PT but were afraid to ask.

MRS. ERVIN TRACY PT

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Provider Prefix Provider Last Name Provider First Name Provider Credential
MRS. ERVIN TRACY PT
Gender:
Female
Enumeration date:
2006-10-16
Last update date:
2013-04-05
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state
805809600 Medicaid none ID

Taxonomies

Taxonomy State License Number Primary?
225100000X Physical Therapist ID RPT1549 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 2087345313
Practice Location Address Telephone Number 2087345313
Mailing Address Fax Number 2087361582

Addresses

Type Address City State Postal Country
Mailing Address 754 N COLLEGE RD SUITE D TWIN FALLS ID 83301 ID
Practice Location Address 754 N COLLEGE RD STE D TWIN FALLS ID 83301 ID

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1629581624 PEERBOOM, MANDY
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1679953962 ASHENBRENER, SAMANTHA
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1861556037 GILLETTE, DENNIS
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754 N COLLEGE RD ID TWIN FALLS
1891858809 WAGNER, CHARLES
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754 N COLLEGE RD ID TWIN FALLS
1982033452 GRAHAM, ANDREW
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775 POLE LINE RD W STE 202 ID TWIN FALLS
1992233555 BIRCHELL, RYAN
Individual
754 N COLLEGE RD STE D ID TWIN FALLS

Other NPI Records that share an address

NPI Name Address State City
1174642961 LITTLE, DAVID
Individual
754 N COLLEGE RD ID TWIN FALLS
1205999281 ELLIS, JULIE
Individual
754 N COLLEGE RD ID TWIN FALLS
1326276882 LAMBERT, MARC
Individual
754 N COLLEGE RD ID TWIN FALLS
1427029610 CENTER FOR PHYSICAL REHABILITA
Organization
754 N COLLEGE RD ID TWIN FALLS
1548323561 PHILLIPS, SETH
Individual
754 N COLLEGE RD ID TWIN FALLS
1679953962 ASHENBRENER, SAMANTHA
Individual
754 N COLLEGE RD ID TWIN FALLS
1861556037 GILLETTE, DENNIS
Individual
754 N COLLEGE RD ID TWIN FALLS
1891858809 WAGNER, CHARLES
Individual
754 N COLLEGE RD ID TWIN FALLS