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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962509018 | NPPES |
| South Carolina | Other | 7796338 | AETNA PROVIDER NUMBER |
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