Provider Demographics
NPI:1427886043
Name:ARGUEDAS, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ARGUEDAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:ELBERTA
Mailing Address - State:UT
Mailing Address - Zip Code:84626-0133
Mailing Address - Country:US
Mailing Address - Phone:801-687-6090
Mailing Address - Fax:
Practice Address - Street 1:55 S PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5637
Practice Address - Country:US
Practice Address - Phone:801-465-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14020541-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist