Provider Demographics
NPI:1073640934
Name:BARDEN, TRACY LYNN (MPT)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNN
Last Name:BARDEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 WARNER AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4476
Mailing Address - Country:US
Mailing Address - Phone:714-743-6626
Mailing Address - Fax:657-204-8991
Practice Address - Street 1:4911 WARNER AVE STE 221
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4476
Practice Address - Country:US
Practice Address - Phone:714-743-6626
Practice Address - Fax:657-204-8991
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist