Wilde, Tracy

Wilde, Tracy is an individual health care provider with primary practice located at 719B Se Main St , Simpsonville SC 29681-3237. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Wilde, Tracy can be contacted via phone (864) 963-9229.

Contact Information

Primary practice address
719B Se Main St Simpsonville SC 29681-3237
Phone: (864) 963-9229
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 1509 South Carolina

Profile Details

NPI number 1962509018
LBN Legal business name Wilde, Tracy
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962509018 NPPES
South Carolina Other 7796338 AETNA PROVIDER NUMBER

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