MEDICARE: MS. ELIZABETH A HETHERWICK PT, DPT, ATP

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	L1379518	MI

General Provider Information

NPI Number	:	1740512839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH A HETHERWICK PT, DPT, ATP

Provider Business Mailing Address
First Line	:	8250 LOCKERBIE RD
Second Line	:
City	:	PARMA
State	:	MI
Zip	:	49269-9335
Country	:	US
Telephone Number	:	517-740-8875
Fax Number	:

Provider Business Practice Location Address
First Line	:	8250 LOCKERBIE RD
Second Line	:
City	:	PARMA
State	:	MI
Zip	:	49269-9335
Country	:	US
Telephone Number	:	517-740-8875
Fax Number	:

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

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	04/22/2013

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