Healthcare Provider Details

I. General information

NPI: 1114986262
Provider Name (Legal Business Name): TRACEY MARIE FLECK MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WHITMORE LAKE RD STE 900
BRIGHTON MI
48116
US

IV. Provider business mailing address

5757 WHITMORE LAKE RD STE 900
BRIGHTON MI
48116
US

V. Phone/Fax

Practice location:
  • Phone: 810-220-5793
  • Fax: 810-220-5805
Mailing address:
  • Phone: 810-220-5793
  • Fax: 810-220-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010794
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: