MEDICARE: MRS. TRACIE PASQUINELLI BARWICK

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	070010445	IL

General Provider Information

NPI Number	:	1407179930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACIE PASQUINELLI BARWICK

Provider Business Mailing Address
First Line	:	16567 PASTURE DR
Second Line	:
City	:	LEMONT
State	:	IL
Zip	:	60439-4578
Country	:	US
Telephone Number	:	630-243-7084
Fax Number	:

Provider Business Practice Location Address
First Line	:	14236 MCCARTHY RD
Second Line	:
City	:	LEMONT
State	:	IL
Zip	:	60439-9393
Country	:	US
Telephone Number	:	708-203-5668
Fax Number	:

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

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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