MEDICARE: MRS. PATRICIA RENEE TKACH P.T.

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	5501011925	MI

General Provider Information

NPI Number	:	1801979679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA RENEE TKACH P.T.

Provider Business Mailing Address
First Line	:	1225 W FRONT ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2368
Country	:	US
Telephone Number	:	231-935-0788
Fax Number	:	231-935-0787

Provider Business Practice Location Address
First Line	:	1225 W FRONT ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2368
Country	:	US
Telephone Number	:	231-935-0788
Fax Number	:	231-935-0787

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	06/07/2014

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