Healthcare Provider Details

I. General information

NPI: 1003432964
Provider Name (Legal Business Name): TRACY LYNN KURFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY LYNN JANSSEN

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PRAIRIE MILLS RD
GOLDEN IL
62339-1055
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 217-696-4446
  • Fax:
Mailing address:
  • Phone: 217-223-8400
  • Fax: 217-277-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160000352
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: