Provider Demographics
NPI:1447339387
Name:FALBO, TRACI LYN (MS, PT, CKTP)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LYN
Last Name:FALBO
Suffix:
Gender:F
Credentials:MS, PT, CKTP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LYN
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT, CKTP
Mailing Address - Street 1:2105 SPRING RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-7807
Mailing Address - Country:US
Mailing Address - Phone:502-836-8222
Mailing Address - Fax:812-796-0116
Practice Address - Street 1:2105 SPRING RIDGE CT
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-7807
Practice Address - Country:US
Practice Address - Phone:502-836-8222
Practice Address - Fax:812-796-0116
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005090A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist