Provider Demographics
NPI:1891073359
Name:TRACCI, MELISSA R (MPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:TRACCI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:18940 EVANS ST STE 106
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-7040
Practice Address - Country:US
Practice Address - Phone:402-933-9111
Practice Address - Fax:402-933-9188
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2024-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE1962225100000X
IACP032576T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist