Healthcare Provider Details

I. General information

NPI: 1982060299
Provider Name (Legal Business Name): TRACY NICOLE POEPPELMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY NICOLE PEARSON PT

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W RUSSELL RD
SIDNEY OH
45365-9063
US

IV. Provider business mailing address

804 W RUSSELL RD
SIDNEY OH
45365-9063
US

V. Phone/Fax

Practice location:
  • Phone: 937-557-5657
  • Fax: 513-230-2024
Mailing address:
  • Phone: 937-557-5657
  • Fax: 513-230-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: