Provider Demographics
NPI:1528494499
Name:TEMMEL, TRACY ANNE (DPT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANNE
Last Name:TEMMEL
Suffix:
Gender:F
Credentials:DPT
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 416501
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 STARR RIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4534
Practice Address - Country:US
Practice Address - Phone:845-414-6161
Practice Address - Fax:845-520-9550
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40472225100000X
NY052124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist