Individual
MARY JANE TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMBT NC #6877
Contact information
Practice address
1800 SUMMEY AVE, CHARLOTTE, NC 28205-7930
(704) 301-5470
Mailing address
1800 SUMMEY AVE, CHARLOTTE, NC 28205-7930
(704) 301-5470
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6877
NC
Other
Enumeration date
08/31/2020
Last updated
08/31/2020
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