Provider Demographics
NPI:1770528531
Name:TRACY, MARCINE THERESA (MA, ATC)
Entity type:Individual
Prefix:MRS
First Name:MARCINE
Middle Name:THERESA
Last Name:TRACY
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30143 395TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:IA
Mailing Address - Zip Code:52031-9646
Mailing Address - Country:US
Mailing Address - Phone:563-872-3005
Mailing Address - Fax:
Practice Address - Street 1:30143 395TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:IA
Practice Address - Zip Code:52031-9646
Practice Address - Country:US
Practice Address - Phone:563-872-3005
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer