Individual
BARRON TRACY SOUTH
Active
Individual
BARRON TRACY SOUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, PT
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
C22172
AR
225100000X
Physical Therapist
Primary
PT 1781
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129332721
—
AR
Enumeration date
01/27/2006
Last updated
09/14/2009
Update your record
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