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General NPI Number Information
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NPI Number | 1063638021
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Entity Type | Individual
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Provider Name | TRACY LANNING PT
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 1001 W BROAD ST
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-8715
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Country | US
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Telephone | 910-862-4042
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 MARYLAND RD
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10984
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT019651
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License Number State | PA
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