Healthcare Provider Details

I. General information

NPI: 1659880201
Provider Name (Legal Business Name): CALVIN TRACY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 DOWLIN FORGE RD
EXTON PA
19341-1548
US

IV. Provider business mailing address

120 W GERMANTOWN PIKE STE 100
PLYMOUTH MEETING PA
19462-1420
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-9060
  • Fax: 610-363-9064
Mailing address:
  • Phone: 610-270-0370
  • Fax: 610-270-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: