MEDICARE: TRACY LEIPOLD

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

General Provider Information

NPI Number	:	1154408839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY LEIPOLD

Provider Business Mailing Address
First Line	:	518 JENNIFER CIR
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4110
Country	:	US
Telephone Number	:	847-566-5935
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 TOWER CT STE A
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-3322
Country	:	US
Telephone Number	:	847-336-7468
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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Directions to “ TRACY LEIPOLD ” Practice Location

Language	Start Address	Practice Location

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