=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407179930
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. TRACIE PASQUINELLI BARWICK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2010
-----------------------------------------------------
Last Update Date | 03/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14236 MCCARTHY RD
-----------------------------------------------------
City | LEMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60439-9393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-203-5668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16567 PASTURE DR
-----------------------------------------------------
City | LEMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60439-4578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-243-7084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070010445
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------