Provider Demographics
NPI:1699911792
Name:TAYLOR, TRACY HELENA (LMT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:HELENA
Last Name:TAYLOR
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 1:4226 FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9259
Mailing Address - Country:US
Mailing Address - Phone:585-749-3426
Mailing Address - Fax:
Practice Address - Street 1:595 BLOSSOM RD
Practice Address - Street 2:SUITE 307
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1825
Practice Address - Country:US
Practice Address - Phone:585-749-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-20
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27018771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist