MEDICARE: TRACY KITCHEN

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	13304	SC

General Provider Information

NPI Number	:	1295662815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY KITCHEN

Provider Business Mailing Address
First Line	:	3010 PERIMETER BLVD APT 309
Second Line	:
City	:	SOUTH PARK
State	:	PA
Zip	:	15129-5537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 WILLIAM HILTON PKWY STE 105
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-2404
Country	:	US
Telephone Number	:	843-682-7301
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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Directions to “ TRACY KITCHEN ” Practice Location

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