Individual
TRACY LYNN WIEBKING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
100 BECKS WOODS DR, SUITE 101, BEAR, DE 19701-3835
(302) 392-3400
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
18976
MD
225100000X
Physical Therapist
Primary
J10000408
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0706628000
AMERIHEALTH
—
01
—
11247945
CAQH
—
05
—
1952458275
—
DE
01
—
5070-0102
GHMSI
MD
01
—
76956616
BC MARYLAND
MD
Enumeration date
01/05/2007
Last updated
03/04/2013
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