| NPI | 1124710827 |
|---|---|
| Former Name | TRACEY ROGERS BUCKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: SC 3077) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-05-22 |