MEDICARE: RACHEL HARTZ

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	2255A2300X	Athletic Trainer	096003387	IL

General Provider Information

NPI Number	:	1124424130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL HARTZ

Provider Business Mailing Address
First Line	:	7234 W 110TH ST
Second Line	:
City	:	WORTH
State	:	IL
Zip	:	60482-1116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7234 W 110TH ST
Second Line	:
City	:	WORTH
State	:	IL
Zip	:	60482-1116
Country	:	US
Telephone Number	:	708-337-0131
Fax Number	:

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

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	11/18/2014

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Directions to “ RACHEL HARTZ ” Practice Location

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