Individual
TRACY MARIE BLACKSTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
404 CLASSCO PL, CLEVELAND, MS 38732-3000
(662) 843-3575
(662) 846-1397
Mailing address
404 CLASSCO PL, CLEVELAND, MS 38732-3000
(662) 843-3575
(662) 846-1397
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2182
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03451326
—
MS
Enumeration date
01/04/2007
Last updated
12/30/2024
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