MEDICARE: MRS. TRACI WIEBUSCH HILL MPT

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		IL

General Provider Information

NPI Number	:	1740297670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACI WIEBUSCH HILL MPT

Provider Business Mailing Address
First Line	:	1760 W DIVERSEY PKWY APT 3E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-7335
Country	:	US
Telephone Number	:	773-750-7648
Fax Number	:	773-327-7470

Provider Business Practice Location Address
First Line	:	900 N NORTH BRANCH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4278
Country	:	US
Telephone Number	:	773-750-7648
Fax Number	:	773-327-7470

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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