Healthcare Provider Details

I. General information

NPI: 1801816939
Provider Name (Legal Business Name): CARRIE A TRACY MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 BOSTON POST RD
ORANGE CT
06477-3229
US

IV. Provider business mailing address

2 BARNES INDUSTRIAL RD S
WALLINGFORD CT
06492-2486
US

V. Phone/Fax

Practice location:
  • Phone: 203-799-8370
  • Fax: 203-466-8527
Mailing address:
  • Phone: 203-626-0160
  • Fax: 203-294-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7573
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7573
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: