MEDICARE: MICHAEL WAWERU

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1194158725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WAWERU

Provider Business Mailing Address
First Line	:	5034 LONGVIEW RD
Second Line	:	APT #12
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-2875
Country	:	US
Telephone Number	:	816-810-2951
Fax Number	:

Provider Business Practice Location Address
First Line	:	5034 LONGVIEW RD
Second Line	:	APT #12
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-2875
Country	:	US
Telephone Number	:	816-810-2951
Fax Number	:

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

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	08/19/2013

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Directions to “ MICHAEL WAWERU ” Practice Location

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