MEDICARE: SHARON LYNN TRACY P. T.

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	2251P0200X	Pediatric Physical Therapist	008169-1	NY
2	2251S0007X	Sports Physical Therapist	0081691-1	NY
3	2251X0800X	Orthopedic Physical Therapist	008169-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QL1361	OTHER	NY	EMPIRE BCBS

General Provider Information

NPI Number	:	1962621946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON LYNN TRACY P. T.

Provider Business Mailing Address
First Line	:	358 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4315
Country	:	US
Telephone Number	:	718-832-7990
Fax Number	:	718-832-7990

Provider Business Practice Location Address
First Line	:	460 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4127
Country	:	US
Telephone Number	:	718-832-7990
Fax Number	:	718-832-7990

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	09/11/2025

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