Healthcare Provider Details

I. General information

NPI: 1891069167
Provider Name (Legal Business Name): TRACY JO VINCENT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W 75TH ST SUITE 250
MERRIAM KS
66204-2209
US

IV. Provider business mailing address

10000 W 75TH ST SUITE 250
MERRIAM KS
66204-2209
US

V. Phone/Fax

Practice location:
  • Phone: 913-894-1910
  • Fax: 877-913-1174
Mailing address:
  • Phone: 913-894-1910
  • Fax: 877-913-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP13567
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberP13567
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: