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General NPI Number Information
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NPI Number | 1376701425
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Entity Type | Individual
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Provider Name | TRACY M CHONG L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 716 W MARKET ST STE A
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City | TIFFIN
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State | OH
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Zip | 44883-2582
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Country | US
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Telephone | 419-443-8877
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Fax | 419-443-8885
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Provider Business Mailing Address
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Address Line | 716 W MARKET ST STE A
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City | TIFFIN
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State | OH
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Zip | 44883-2582
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Country | US
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Telephone | 419-443-8877
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Fax | 419-443-8885
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 13311
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License Number State | OH
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