MEDICARE: MATTHEW ROBERT TRACEY DPT

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	225100000X	Physical Therapist	P21934	NC

General Provider Information

NPI Number	:	1962117689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ROBERT TRACEY DPT

Provider Business Mailing Address
First Line	:	1429 BRYANT ST STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5201
Country	:	US
Telephone Number	:	704-919-0867
Fax Number	:	704-817-8579

Provider Business Practice Location Address
First Line	:	170 JOE KNOX AVE
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9169
Country	:	US
Telephone Number	:	704-360-2779
Fax Number	:	704-360-2775

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

Provider Enumeration Date	:	01/17/2023
Last Update Date	:	01/08/2026

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