1801993845 NPI number — TRACY GAGNON STROBEL MPT

Table of content: TRACY GAGNON STROBEL MPT (NPI 1801993845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801993845 NPI number — TRACY GAGNON STROBEL MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROBEL
Provider First Name:
TRACY
Provider Middle Name:
GAGNON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPIEGEL
Provider Other First Name:
TRACY
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801993845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4955 STEUBENVILLE PIKE
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15205-9619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-722-1180
Provider Business Mailing Address Fax Number:
412-722-1160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4955 STEUBENVILLE PIKE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-722-1180
Provider Business Practice Location Address Fax Number:
412-722-1160
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT013479L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)