Healthcare Provider Details

I. General information

NPI: 1053924340
Provider Name (Legal Business Name): TRACY JANETTE CISNEROS PT, DPT, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HILLCREST MEDICAL BLVD STE 102
WACO TX
76712-8953
US

IV. Provider business mailing address

PO BOX 848491
DALLAS TX
75284-8491
US

V. Phone/Fax

Practice location:
  • Phone: 254-202-7900
  • Fax: 254-202-7949
Mailing address:
  • Phone: 254-202-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1294772
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: