MEDICARE: MRS. TRACY MAE FRIED 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
1	225100000X	Physical Therapist	040-0003237	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	68576	OTHER	VT	BCBS

General Provider Information

NPI Number	:	1851328009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY MAE FRIED PT

Provider Business Mailing Address
First Line	:	PO BOX 1346
Second Line	:
City	:	LYNDONVILLE
State	:	VT
Zip	:	05851-1346
Country	:	US
Telephone Number	:	802-626-4224
Fax Number	:	802-626-5042

Provider Business Practice Location Address
First Line	:	31 MIDDLE ST
Second Line	:
City	:	LYNDONVILLE
State	:	VT
Zip	:	05851-1346
Country	:	US
Telephone Number	:	802-626-4224
Fax Number	:	802-626-5042

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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