Provider Demographics
NPI:1861696072
Name:BARBER, TRACIE (PT)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:BARBER
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 1:12656 W GEAUGA PLZ
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2505
Mailing Address - Country:US
Mailing Address - Phone:440-688-4186
Mailing Address - Fax:440-686-4187
Practice Address - Street 1:12656 W GEAUGA PLZ
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2505
Practice Address - Country:US
Practice Address - Phone:440-688-4186
Practice Address - Fax:440-686-4187
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT007276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH486930OtherMEDICARE PTAN
OH2470437Medicaid