Provider Demographics
NPI:1053945139
Name:NWEZE-THOMAS, TRACEY (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:NWEZE-THOMAS
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19419 GULF FWY STE 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-2809
Mailing Address - Country:US
Mailing Address - Phone:281-488-2815
Mailing Address - Fax:281-488-2844
Practice Address - Street 1:19419 GULF FWY STE 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-2809
Practice Address - Country:US
Practice Address - Phone:281-488-2815
Practice Address - Fax:281-488-2844
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1234021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist