Healthcare Provider Details

I. General information

NPI: 1205919198
Provider Name (Legal Business Name): ROBIN CATHERINE TRACY PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S COLUMBIA RD
GRAND FORKS ND
58201-4039
US

IV. Provider business mailing address

PO BOX I
PARK RIVER ND
58270-0708
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-8374
  • Fax: 701-780-0885
Mailing address:
  • Phone: 701-284-4570
  • Fax: 701-284-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number972
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number137-94
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: