MEDICARE: MRS. CAROLE BARBER TIEDEMAN PT PHYSICAL THERAPIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	75	SC

General Provider Information

NPI Number	:	1073523130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLE BARBER TIEDEMAN PT PHYSICAL THERAPIS

Provider Business Mailing Address
First Line	:	1490 NAUTILUS RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732
Country	:	US
Telephone Number	:	803-366-1926
Fax Number	:	803-366-4444

Provider Business Practice Location Address
First Line	:	1169 EBENEZER RD STE C
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2364
Country	:	US
Telephone Number	:	803-324-5370
Fax Number	:	803-324-7650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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