Provider Demographics
NPI:1215097191
Name:BAUN, TRACILYN (BSPT)
Entity type:Individual
Prefix:MS
First Name:TRACILYN
Middle Name:
Last Name:BAUN
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:MRS
Other - First Name:TRACILYN
Other - Middle Name:
Other - Last Name:CULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSPT
Mailing Address - Street 1:28 OLYMPIA LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4011
Mailing Address - Country:US
Mailing Address - Phone:856-952-0844
Mailing Address - Fax:
Practice Address - Street 1:300 HARPER DR
Practice Address - Street 2:
Practice Address - City:MOOERESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-552-1300
Practice Address - Fax:856-552-1308
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00566800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2369948000OtherAMERIHEALTH
NJP00216846OtherRAILROAD MCR
NJP00216846OtherRAILROAD MCR