=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194869362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE S. TRACY P. T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 RIVERWOODS DR
-----------------------------------------------------
City | NEW HOPE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18938-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-862-1135
-----------------------------------------------------
Fax | 215-862-1135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 RIVERWOODS DR
-----------------------------------------------------
City | NEW HOPE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18938-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-862-1135
-----------------------------------------------------
Fax | 215-862-1135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT-002663-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA00108700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 00PT24360
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------