=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689430274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY DAWN SLAUGHTER MSPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2024
-----------------------------------------------------
Last Update Date | 02/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 398 FREEMAN ST
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32750-4171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-682-3600
-----------------------------------------------------
Fax | 407-682-7400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 198 BLUE FLAX PT
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32750-3467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-782-7849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | PT12677
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------