Healthcare Provider Details

I. General information

NPI: 1588844096
Provider Name (Legal Business Name): TRACY M JOHN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 BROCKETT WALK
TUCKER GA
30084-6402
US

IV. Provider business mailing address

3998 BROCKETT WALK
TUCKER GA
30084-6402
US

V. Phone/Fax

Practice location:
  • Phone: 470-440-1175
  • Fax:
Mailing address:
  • Phone: 470-440-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP032318T
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009899
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: