Provider Demographics
NPI:1578665865
Name:PARSONS, TRACY KRISTIN (MS PT)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:KRISTIN
Last Name:PARSONS
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:KRISTIN
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:5008 8TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820
Mailing Address - Country:US
Mailing Address - Phone:916-452-7593
Mailing Address - Fax:
Practice Address - Street 1:2101 STONE BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691
Practice Address - Country:US
Practice Address - Phone:916-617-2400
Practice Address - Fax:916-617-2403
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist