Healthcare Provider Details

I. General information

NPI: 1154562643
Provider Name (Legal Business Name): TRAC SERVICES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ROLAND DR
ALBANY NY
12208-1023
US

IV. Provider business mailing address

PO BOX 1092
LATHAM NY
12110-0059
US

V. Phone/Fax

Practice location:
  • Phone: 518-435-1295
  • Fax:
Mailing address:
  • Phone: 518-435-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number007063-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number002113-1
License Number StateNY

VIII. Authorized Official

Name: MRS. TERRI JOHNSON
Title or Position: PARTNER
Credential: PTA
Phone: 518-435-1295