Provider Demographics
NPI:1740297670
Name:HILL, TRACI WIEBUSCH (MPT)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:WIEBUSCH
Last Name:HILL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:WIEBUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1760 W DIVERSEY PKWY APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7335
Mailing Address - Country:US
Mailing Address - Phone:773-750-7648
Mailing Address - Fax:773-327-7470
Practice Address - Street 1:900 N NORTH BRANCH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4278
Practice Address - Country:US
Practice Address - Phone:773-750-7648
Practice Address - Fax:773-327-7470
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14326Medicare ID - Type Unspecified