Provider Demographics
NPI:1396194114
Name:HUNTER, TRACY RENEE (LMT)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:RENEE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 HAWKINS RD
Mailing Address - Street 2:
Mailing Address - City:CRAWLEY
Mailing Address - State:WV
Mailing Address - Zip Code:24931-7097
Mailing Address - Country:US
Mailing Address - Phone:304-392-1093
Mailing Address - Fax:
Practice Address - Street 1:203 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1316
Practice Address - Country:US
Practice Address - Phone:304-646-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2000-0534225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist