Provider Demographics
NPI:1144471285
Name:STOUDT, TRACY UMSTOT (MSPT)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:UMSTOT
Last Name:STOUDT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-9000
Mailing Address - Country:US
Mailing Address - Phone:610-944-7319
Mailing Address - Fax:
Practice Address - Street 1:2125 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19605-2259
Practice Address - Country:US
Practice Address - Phone:610-921-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010008L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist