Provider Demographics
NPI:1679723696
Name:INFALVI, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:INFALVI
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 1:9930 JOHNNYCAKE RIDGE RD STE 6B
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6766
Mailing Address - Country:US
Mailing Address - Phone:440-357-6677
Mailing Address - Fax:440-357-6681
Practice Address - Street 1:9930 JOHNNYCAKE RIDGE RD STE 6B
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6766
Practice Address - Country:US
Practice Address - Phone:440-357-6677
Practice Address - Fax:440-357-6681
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4131225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4131OtherPHYSICAL THERAPY ASSISTANT