Healthcare Provider Details

I. General information

NPI: 1306777339
Provider Name (Legal Business Name): TRACY BROWN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6433 TUPELO DR
CITRUS HEIGHTS CA
95621-1747
US

IV. Provider business mailing address

6433 TUPELO DR
CITRUS HEIGHTS CA
95621-1747
US

V. Phone/Fax

Practice location:
  • Phone: 916-660-2187
  • Fax:
Mailing address:
  • Phone: 916-660-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number67204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: