MEDICARE: TRACY SOUZA

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
1	225700000X	Massage Therapist	9393	AR

General Provider Information

NPI Number	:	1508622986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY SOUZA

Provider Business Mailing Address
First Line	:	3401 ROGERS AVE STE E
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2986
Country	:	US
Telephone Number	:	479-217-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 ROGERS AVE STE E
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2986
Country	:	US
Telephone Number	:	479-217-1240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2024
Last Update Date	:	02/23/2024

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Directions to “ TRACY SOUZA ” Practice Location

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