Healthcare Provider Details

I. General information

NPI: 1215065271
Provider Name (Legal Business Name): TRACY LYNN KRAUSE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY LYNN ERNST DPT

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7609 BROCKWAY ROAD
YALE MI
48097
US

IV. Provider business mailing address

5590 MAIN ST. SUITE 4
LEXINGTON MI
48450
US

V. Phone/Fax

Practice location:
  • Phone: 810-387-4900
  • Fax: 810-387-9200
Mailing address:
  • Phone: 810-359-8700
  • Fax: 810-359-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501013227
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: