Healthcare Provider Details

I. General information

NPI: 1518578186
Provider Name (Legal Business Name): TRACY TRAN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2020
Last Update Date: 08/16/2020
Certification Date: 08/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5166 EAGLE ROCK BLVD
LOS ANGELES CA
90041-1115
US

IV. Provider business mailing address

5166 EAGLE ROCK BLVD
LOS ANGELES CA
90041-1115
US

V. Phone/Fax

Practice location:
  • Phone: 949-419-4776
  • Fax:
Mailing address:
  • Phone: 949-419-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY TRAN
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 949-419-4776