Provider Demographics
NPI:1336998319
Name:BARDFIELD, TRACY R (PTA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:R
Last Name:BARDFIELD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10541 N MACARTHUR BLVD APT 1092
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5299
Mailing Address - Country:US
Mailing Address - Phone:214-356-6462
Mailing Address - Fax:
Practice Address - Street 1:10541 N MACARTHUR BLVD APT 1092
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5299
Practice Address - Country:US
Practice Address - Phone:214-356-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21179992251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics