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Individual
TRACEY BLACK POWELL
Active
Individual
TRACEY BLACK POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1762
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1543A
BCBS
NC
05
—
7212716
—
NC
Enumeration date
10/21/2009
Last updated
10/30/2014
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