MEDICARE: TERESA TRAUT PT

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	PT009833	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT009833	OTHER	GA	STATE LICENSE

General Provider Information

NPI Number	:	1184938318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA TRAUT PT

Provider Business Mailing Address
First Line	:	1061 SOUTHWIND DR
Second Line	:
City	:	BISHOP
State	:	GA
Zip	:	30621-1361
Country	:	US
Telephone Number	:	706-705-1252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 SOUTHWIND DR
Second Line	:
City	:	BISHOP
State	:	GA
Zip	:	30621-1361
Country	:	US
Telephone Number	:	706-705-1252
Fax Number	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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Directions to “ TERESA TRAUT PT” Practice Location

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