MEDICARE: TRACEY WILLIFORD

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	PT0005667	FL

General Provider Information

NPI Number	:	1164875944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY WILLIFORD

Provider Business Mailing Address
First Line	:	1025 CORDOVA RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1449
Country	:	US
Telephone Number	:	954-868-2214
Fax Number	:	954-491-4492

Provider Business Practice Location Address
First Line	:	1025 CORDOVA RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1449
Country	:	US
Telephone Number	:	954-868-2214
Fax Number	:	954-491-4492

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

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	07/18/2016

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Directions to “ TRACEY WILLIFORD ” Practice Location

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