Provider Demographics
NPI:1538199146
Name:RANDALL, TRACY L (ATC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:RANDALL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MINNICH RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7900
Mailing Address - Country:US
Mailing Address - Phone:717-264-4141
Mailing Address - Fax:
Practice Address - Street 1:1015 PHILADELPHIA AVE
Practice Address - Street 2:#54
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1279
Practice Address - Country:US
Practice Address - Phone:717-496-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer