Individual
MS. TRACEY EVATE VIRGIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5000
Mailing address
204 HAWTHORN DR, RAEFORD, NC 28376-5688
(910) 875-8605
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3523
NC
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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