Provider Demographics
NPI:1962117689
Name:TRACEY, MATTHEW (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:TRACEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8918 BLAKENEY PROFESSIONAL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6692
Mailing Address - Country:US
Mailing Address - Phone:704-900-8960
Mailing Address - Fax:704-817-9523
Practice Address - Street 1:18831 STATESVILLE RD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6755
Practice Address - Country:US
Practice Address - Phone:704-897-6145
Practice Address - Fax:704-897-7503
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2025-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NCP21934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist