Individual provider Active NPI

Kristen Ann Tracey, DPT

  • Physical Therapist
  • Bronx, NY
National Provider Identifier
1861795122
Registry record updated Mar 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
033328 Issued in NY
Practice address
55 Knolls Cres Apt 11a
Bronx, NY 10463
Phone
(718) 644-6291
NPI assigned
Dec 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 033328 NY Primary

Addresses

Primary practice location

55 Knolls Cres Apt 11a
Bronx, NY 10463

Mailing address

55 Knolls Cres Apt 11a
Bronx, NY 10463-6355
Phone (718) 644-6291

Other practice location 1

1053 W Boston Post Rd
Mamaroneck, NY 10543-3329
Phone (914) 381-0203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110519000001 NY Practitioner - Physical Therapist in Private Practice 9032395470 Reassigns benefits to 3 organizations
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
033328NYMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Balanced Body Physical Therapy PLLC Physical Therapist CurrentSince May 1, 2020 Accepting new patients
Stern at Home Physical Therapy PC Physical Therapist CurrentSince Apr 20, 2019 Accepting new patients

Locations

23 Robert Pitt Dr
Ste 110
Monsey, NY 10952

4 Medical Park Dr
Ste B
Pomona, NY 10970
Phone (845) 354-3131

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553126400000",
    "number": "1861795122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 KNOLLS CRES APT 11A",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104636355",
            "telephone_number": "718-644-6291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 KNOLLS CRES APT 11A",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10463",
            "telephone_number": "718-644-6291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1053 W Boston Post Rd",
            "address_purpose": "LOCATION",
            "city": "Mamaroneck",
            "state": "NY",
            "postal_code": "105433329",
            "country_code": "US",
            "telephone_number": "914-381-0203",
            "fax_number": "914-381-0207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRACEY",
        "first_name": "KRISTEN",
        "middle_name": "ANN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-08",
        "last_updated": "2019-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "033328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.