MEDICARE: MRS. TRACY LIN BOONE 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	009251	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932224979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY LIN BOONE PT

Provider Business Mailing Address
First Line	:	818 MASSACHUSETTS DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1704
Country	:	US
Telephone Number	:	513-943-9624
Fax Number	:	513-943-9624

Provider Business Practice Location Address
First Line	:	431 OHIO PIKE
Second Line	:	SUITE 108
City	:	CINCINNATI
State	:	OH
Zip	:	45255-3375
Country	:	US
Telephone Number	:	513-528-3100
Fax Number	:	513-528-3533

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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