MEDICARE: FAITH MCCORMACK 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	0000006956	TN
2	225100000X	Physical Therapist	PT3688	MS
3	225100000X	Physical Therapist	005527	NY

General Provider Information

NPI Number	:	1053433771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH MCCORMACK P.T.

Provider Business Mailing Address
First Line	:	9754 PINE POINT DR
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-8402
Country	:	US
Telephone Number	:	901-382-5052
Fax Number	:	901-382-5052

Provider Business Practice Location Address
First Line	:	9754 PINE POINT DR
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-8402
Country	:	US
Telephone Number	:	901-382-5052
Fax Number	:	901-382-5052

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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