Provider Demographics
NPI:1871754101
Name:RICHARDSON, TRACY L (LMT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 PLUMAS ST
Mailing Address - Street 2:#321
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4159
Mailing Address - Country:US
Mailing Address - Phone:775-338-5353
Mailing Address - Fax:
Practice Address - Street 1:1101 W MOANA LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4775
Practice Address - Country:US
Practice Address - Phone:775-338-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4007172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist