Provider Demographics
NPI:1528667417
Name:ROSIENE, TRACY L (LMT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:ROSIENE
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 1:211 ROUTE 164
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06365-8726
Mailing Address - Country:US
Mailing Address - Phone:860-889-0238
Mailing Address - Fax:
Practice Address - Street 1:211 ROUTE 164
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:CT
Practice Address - Zip Code:06365-8726
Practice Address - Country:US
Practice Address - Phone:860-303-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist