Provider Demographics
NPI:1215065271
Name:KRAUSE, TRACY LYNN (DPT)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5590 MAIN ST.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEXINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48450
Mailing Address - Country:US
Mailing Address - Phone:810-359-8700
Mailing Address - Fax:810-359-8702
Practice Address - Street 1:7609 BROCKWAY ROAD
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097
Practice Address - Country:US
Practice Address - Phone:810-387-4900
Practice Address - Fax:810-387-9200
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist