Provider Demographics
NPI:1861964942
Name:POWERS, TRACY ANN (PTA)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:POWERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:BINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7244 WELLSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2435
Mailing Address - Country:US
Mailing Address - Phone:865-963-7380
Mailing Address - Fax:
Practice Address - Street 1:2320 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5316
Practice Address - Country:US
Practice Address - Phone:865-273-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6992225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant