Provider Demographics
NPI:1144873639
Name:PATTON, TRACY ANN (PT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:PATTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 LIME KILN LN STE B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3429
Mailing Address - Country:US
Mailing Address - Phone:502-493-6979
Mailing Address - Fax:907-917-2834
Practice Address - Street 1:2415 LIME KILN LN STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3429
Practice Address - Country:US
Practice Address - Phone:502-493-6979
Practice Address - Fax:907-917-2834
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist