Provider Demographics
NPI:1104915131
Name:WHITMAN, TRACY S (PT)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:S
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:S
Other - Last Name:HORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:34 GREYTHORNE WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4758
Mailing Address - Country:US
Mailing Address - Phone:610-995-2727
Mailing Address - Fax:
Practice Address - Street 1:34 GREYTHORNE WOODS CIR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4758
Practice Address - Country:US
Practice Address - Phone:610-995-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002487L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0097300000OtherPERSONAL CHOICE (INDEPBC)
PA0800696OtherAETNA HMO
PA400214OtherHIGHMARK BS
PA438299OtherAETNA PPO
PA438299OtherAETNA PPO