=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750545372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACEY C. MURTHA P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2008
-----------------------------------------------------
Last Update Date | 07/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1610 S MARTHA CT
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-309-8781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1610 S MARTHA CT
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-309-8781
-----------------------------------------------------
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 | 0000001910
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------