MEDICARE: MRS. TRACY LEE GARAVAGLIA M.P.T., A.T.C.

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	001917	WV

General Provider Information

NPI Number	:	1164401162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY LEE GARAVAGLIA M.P.T., A.T.C.

Provider Business Mailing Address
First Line	:	2A CHERRY TREE DR
Second Line	:
City	:	NUTTER FORT
State	:	WV
Zip	:	26301-4475
Country	:	US
Telephone Number	:	304-622-5822
Fax Number	:	304-622-9707

Provider Business Practice Location Address
First Line	:	2A CHERRY TREE DR
Second Line	:
City	:	NUTTER FORT
State	:	WV
Zip	:	26301-4475
Country	:	US
Telephone Number	:	304-622-5822
Fax Number	:	304-622-9707

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/09/2007

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