MEDICARE: TRACY L HILTZ PT

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	5699	OH

General Provider Information

NPI Number	:	1265400642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY L HILTZ PT

Provider Business Mailing Address
First Line	:	161 BRIARBEND BLVD
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-9383
Country	:	US
Telephone Number	:	614-840-0852
Fax Number	:

Provider Business Practice Location Address
First Line	:	6021 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2256
Country	:	US
Telephone Number	:	614-839-7289
Fax Number	:

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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