Traci Lynn Roon, PT
Individual provider Active NPI Physical Therapist · Fairbanks, AK
NPI 1164573952 · NPPES record last updated Feb 19, 2013
Key facts
- NPI
- 1164573952
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1106 (AK)
- Practice address
- 398 Hamilton Ave
Fairbanks, AK 99701-3537 - Phone
- (907) 374-4911
- Fax
- (907) 374-4934
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1106 | AK | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1106 | AK | Yes |
Addresses
Primary practice location
398 Hamilton Ave
Fairbanks, AK 99701-3537
Mailing address
398 Hamilton Ave
Fairbanks, AK 99701-3537
Phone (907) 374-4911
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT6220 | Medicaid | AK |
Other providers in Fairbanks, AK
- Vernon Gene Rohrer
- Hailee Renee Romig
- Catherine Romine
- Irmgard Jo Romine
- Ronald M. Teel DDS, PC
- Lisa Root
- Nikki Rosauer
- Carol J Rose
- Heidi Eileen Rose
- Jeri Rosenbloom
All providers in Fairbanks, AK · Physical Therapist in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.