MEDICARE: MARY ELIZABETH THATCHER P.T.

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	2249	KY

General Provider Information

NPI Number	:	1679601686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH THATCHER P.T.

Provider Business Mailing Address
First Line	:	1849 FREEDOM TRAIL DR
Second Line	:
City	:	INDEPENDENCE
State	:	KY
Zip	:	41051-7600
Country	:	US
Telephone Number	:	859-356-1268
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 TOWN DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076-9138
Country	:	US
Telephone Number	:	859-572-0710
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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