Provider Demographics
NPI:1174659023
Name:STANTON, TRACIE JANICE (MSPT)
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:JANICE
Last Name:STANTON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13103 S HALLET CT
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6220
Mailing Address - Country:US
Mailing Address - Phone:913-780-4943
Mailing Address - Fax:
Practice Address - Street 1:13103 S HALLET CT
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6220
Practice Address - Country:US
Practice Address - Phone:913-780-4943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist