Provider Demographics
NPI:1023723749
Name:TRACEY, CHARLEE (DPT)
Entity type:Individual
Prefix:
First Name:CHARLEE
Middle Name:
Last Name:TRACEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHARLEE
Other - Middle Name:
Other - Last Name:BODWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8918 BLAKENEY PROFESSIONAL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6692
Mailing Address - Country:US
Mailing Address - Phone:704-900-8960
Mailing Address - Fax:704-817-9523
Practice Address - Street 1:8100 OLD MALLARD CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2238
Practice Address - Country:US
Practice Address - Phone:980-299-2048
Practice Address - Fax:980-299-2050
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist