Healthcare Provider Details

I. General information

NPI: 1295662815
Provider Name (Legal Business Name): TRACY KITCHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 WILLIAM HILTON PKWY STE 105
HILTON HEAD ISLAND SC
29926-2404
US

IV. Provider business mailing address

3010 PERIMETER BLVD APT 309
SOUTH PARK PA
15129-5537
US

V. Phone/Fax

Practice location:
  • Phone: 843-682-7301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13304
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: