Basic Information
| Provider Information | |||||||||
| NPI: | 1881903730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAHAK | ||||||||
| FirstName: | TRACEE | ||||||||
| MiddleName: | BLACKLOCK | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 S RUIDOSA DOWNS DR | ||||||||
| Address2: | |||||||||
| City: | ROBINSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767067254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546623767 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 WOODGATE DR | ||||||||
| Address2: | |||||||||
| City: | WOODWAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767128600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546665454 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2010 | ||||||||
| LastUpdateDate: | 09/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251G0304X | 1051282 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.