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NPI Code Detail

MEDICARE: TRACY LYN FARREY PT

MEDICARE: TRACY LYN FARREY PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4900OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104809052
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY LYN FARREY PT
Provider Business Mailing Address
First Line : 11481 SW HALL BLVD
Second Line : STE 201
City : PORTLAND
State : OR
Zip : 97223-8403
Country : US
Telephone Number : 800-219-8835
Fax Number : 503-443-1402
Provider Business Practice Location Address
First Line : 1271 N 6TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3360
Country : US
Telephone Number : 414-978-9100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 08/12/2019

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Directions to “ TRACY LYN FARREY PT” Practice Location

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