Provider Demographics
NPI:1659817443
Name:BORAS, TRACY ELIZABETH (MS PT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:BORAS
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 ARISTA PL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4154
Mailing Address - Country:US
Mailing Address - Phone:720-777-9195
Mailing Address - Fax:
Practice Address - Street 1:8401 ARISTA PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-4154
Practice Address - Country:US
Practice Address - Phone:720-777-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0007682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist