MEDICARE: ERIC TIETZ

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	009531	CT

General Provider Information

NPI Number	:	1689935074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC TIETZ

Provider Business Mailing Address
First Line	:	76 WESTBURY PARK RD
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-2779
Country	:	US
Telephone Number	:	860-274-7573
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 WESTBURY PARK RD
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-2779
Country	:	US
Telephone Number	:	860-274-7573
Fax Number	:

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

Provider Enumeration Date	:	06/03/2012
Last Update Date	:	05/06/2026

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Directions to “ ERIC TIETZ ” Practice Location

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