Healthcare Provider Details

I. General information

NPI: 1639724990
Provider Name (Legal Business Name): BRYCE WILLIAM TRACY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 BRODIE LN STE 640
SUNSET VALLEY TX
78745-2551
US

IV. Provider business mailing address

PO BOX 306393
NASHVILLE TN
37230-6393
US

V. Phone/Fax

Practice location:
  • Phone: 512-580-3055
  • Fax: 512-580-3056
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-221-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1322750
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: