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General NPI Number Information
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NPI Number | 1588079743
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Entity Type | Individual
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Provider Name | TRACY SIMILUK PT
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Gender | Female
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 100 AUGUSTA RD APT 121
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-0228
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Country | US
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Telephone | 850-814-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 100 AUGUSTA RD APT 121
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-0228
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Country | US
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Telephone | 850-814-9711
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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 | 15058
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License Number State | FL
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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 | 60670
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3626
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 002728
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License Number State | WV
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