Provider Demographics
NPI:1174145742
Name:HARCOURT, TRACY JO (PT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:JO
Last Name:HARCOURT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 COURTLAND DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4027
Mailing Address - Country:US
Mailing Address - Phone:650-589-8352
Mailing Address - Fax:
Practice Address - Street 1:336 COURTLAND DR
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-4027
Practice Address - Country:US
Practice Address - Phone:650-589-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist