Provider Demographics
NPI:1285799882
Name:MAGNUSSON, TRACY DEE (PT)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DEE
Last Name:MAGNUSSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2381 MAGDA CIR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1829
Mailing Address - Country:US
Mailing Address - Phone:805-494-4536
Mailing Address - Fax:
Practice Address - Street 1:2381 MAGDA CIR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1829
Practice Address - Country:US
Practice Address - Phone:805-494-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist