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General NPI Number Information
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NPI Number | 1588844096
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Entity Type | Individual
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Provider Name | TRACY M JOHN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 203 N WASHINGTON HWY
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City | ASHLAND
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State | VA
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Zip | 23005-1623
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Country | US
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Telephone | 804-798-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 3998 BROCKETT WALK
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City | TUCKER
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State | GA
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Zip | 30084-6402
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Country | US
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Telephone | 470-440-1175
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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 | CP032318T
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License Number State | VA
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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 | 009899
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License Number State | GA
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