Individual
TRACEY RENEE BRAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19900 S MAIN ST STE 4, CORNELIUS, NC 28031-6513
(704) 777-8919
Mailing address
10061 SWITCHYARD DR, CORNELIUS, NC 28031-8115
(704) 777-8919
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19730
NC
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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