Individual
TRACY ANN DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC, PTA
Contact information
Practice address
200 N EMERALD LN STE 1A, CARBONDALE, IL 62901-2100
(618) 549-9449
Mailing address
201 CYPRESS AVE, ELKVILLE, IL 62932-2526
(618) 568-2543
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
—
IL
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
03/22/2007
Last updated
09/11/2025
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