MEDICARE: MARIAN H WADE 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	013256-1	NY

General Provider Information

NPI Number	:	1306091269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN H WADE PT

Provider Business Mailing Address
First Line	:	50 MORNINGSIDE DR
Second Line	:	#32
City	:	NEW YORK
State	:	NY
Zip	:	10025-1756
Country	:	US
Telephone Number	:	212-866-0648
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 MORNINGSIDE DR
Second Line	:	#32
City	:	NEW YORK
State	:	NY
Zip	:	10025-1739
Country	:	US
Telephone Number	:	212-866-0648
Fax Number	:

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

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	12/06/2011

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