Provider Demographics
NPI:1518412162
Name:BETTS, TRACI TIEMANN (DPT, CCS)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:TIEMANN
Last Name:BETTS
Suffix:
Gender:F
Credentials:DPT, CCS
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:JEAN
Other - Last Name:TIEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, CCS
Mailing Address - Street 1:6011 HARRY HINES BLVD
Mailing Address - Street 2:SUITE V6. 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5386
Mailing Address - Country:US
Mailing Address - Phone:214-648-1551
Mailing Address - Fax:
Practice Address - Street 1:6011 HARRY HINES BLVD
Practice Address - Street 2:SUITE V6. 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5386
Practice Address - Country:US
Practice Address - Phone:214-648-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12310602251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary