Healthcare Provider Details

I. General information

NPI: 1154422285
Provider Name (Legal Business Name): TRACY DANIELLE CROSS MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 LINCOLN RD
HAMILTON MI
49419-9512
US

IV. Provider business mailing address

44 E 8TH ST SUITE 205
HOLLAND MI
49423-3575
US

V. Phone/Fax

Practice location:
  • Phone: 269-751-2150
  • Fax: 269-751-2140
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012660
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: