Provider Demographics
NPI:1447274816
Name:SIMPSON, TRACY LAVON (MPT)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LAVON
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:LAVON
Other - Last Name:CASTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:22278 NORTHWESTERN PIKE
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757
Mailing Address - Country:US
Mailing Address - Phone:304-822-6024
Mailing Address - Fax:304-822-7989
Practice Address - Street 1:22278 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757
Practice Address - Country:US
Practice Address - Phone:304-822-6024
Practice Address - Fax:304-822-7989
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20809225100000X
WV001922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist