Provider Demographics
NPI:1861746828
Name:HYDE, TRACY J
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:J
Last Name:HYDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:COLOGNE
Mailing Address - State:MN
Mailing Address - Zip Code:55322-9000
Mailing Address - Country:US
Mailing Address - Phone:952-442-8648
Mailing Address - Fax:
Practice Address - Street 1:10025 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:COLOGNE
Practice Address - State:MN
Practice Address - Zip Code:55322-9000
Practice Address - Country:US
Practice Address - Phone:952-442-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist