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1972979011

NPI Code Detail

MEDICARE: RACHEL TIRY

MEDICARE: RACHEL TIRY

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	10000	MN
2	225100000X	Physical Therapist	PTL.0016139	CO
3	225100000X	Physical Therapist	PT60735047	WA
4	225100000X	Physical Therapist	P19151	NC
5	225100000X	Physical Therapist	24047	MA
6	225100000X	Physical Therapist	62598	OR

General Provider Information

NPI Number	:	1972979011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL TIRY

Provider Business Mailing Address
First Line	:	4124 PEBBLE BEACH COURT
Second Line	:
City	:	FRANKLIN
State	:	WI
Zip	:	53132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5430 BOONE AVE N
Second Line	:
City	:	NEW HOPE
State	:	MN
Zip	:	55428-3615
Country	:	US
Telephone Number	:	763-592-2600
Fax Number	:

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

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	05/11/2021

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Directions to “ RACHEL TIRY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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