MEDICARE: DR. THERESA HNATH-CHISOLM PH.D.

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	231H00000X	Audiologist	AY149	FL

General Provider Information

NPI Number	:	1093818908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA HNATH-CHISOLM PH.D.

Provider Business Mailing Address
First Line	:	2906 W BAY VILLA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1606
Country	:	US
Telephone Number	:	813-974-9826
Fax Number	:	813-974-0822

Provider Business Practice Location Address
First Line	:	4202 E FOWLER AVEUNE
Second Line	:	UNIVERSITY OF SOUTH FLORIDA PCD 1017
City	:	TAMPA
State	:	FL
Zip	:	33620
Country	:	US
Telephone Number	:	813-974-9826
Fax Number	:	813-974-0822

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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