MEDICARE: TRACY THURMOND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1389568	TX

General Provider Information

NPI Number	:	1770003600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY THURMOND

Provider Business Mailing Address
First Line	:	PO BOX 156402
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76155-1402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 156402
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76155-1402
Country	:	US
Telephone Number	:	682-230-5458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	03/08/2026

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Directions to “ TRACY THURMOND ” Practice Location

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