Healthcare Provider Details

I. General information

NPI: 1992613053
Provider Name (Legal Business Name): TRACY VILLALOBOS CAMPOS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SEAGRASS STATION RD
BLUFFTON SC
29910-9549
US

IV. Provider business mailing address

15 CALIBOGUE CAY RD APT 397
HILTON HEAD ISLAND SC
29928-2938
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-8200
  • Fax:
Mailing address:
  • Phone: 843-836-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.13538
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: