Provider Demographics
NPI:1962621946
Name:TRACY, SHARON LYNN (P T)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:TRACY
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4315
Mailing Address - Country:US
Mailing Address - Phone:718-832-7990
Mailing Address - Fax:718-832-7990
Practice Address - Street 1:460 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4127
Practice Address - Country:US
Practice Address - Phone:718-832-7990
Practice Address - Fax:718-832-7990
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008169-12251P0200X, 2251X0800X
NY0081691-12251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL1361OtherEMPIRE BCBS