Healthcare Provider Details

I. General information

NPI: 1912028416
Provider Name (Legal Business Name): TRACY LYNNE CIOFFI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ARGO DR
SEWELL NJ
08080-1908
US

IV. Provider business mailing address

22 ARGO DR
SEWELL NJ
08080-1908
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-1009
  • Fax:
Mailing address:
  • Phone: 856-589-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00082800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: