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NPI Code Detail

MEDICARE: TRACY G HEIM PT

MEDICARE:   TRACY G HEIM  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
1225100000XPhysical Therapist5797WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15797-024OTHERWILICENSE

General Provider Information

NPI Number : 1548245152
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY G HEIM PT
Provider Business Mailing Address
First Line : PO BOX 19070
Second Line :
City : GREEN BAY
State : WI
Zip : 54307-9070
Country : US
Telephone Number : 920-496-4700
Fax Number :
Provider Business Practice Location Address
First Line : 3021 VOYAGER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8303
Country : US
Telephone Number : 920-430-4750
Fax Number : 920-430-4746
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 08/02/2016

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Directions to “ TRACY G HEIM PT” Practice Location

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