MEDICARE: SARAH EMILY WALTZMAN L.AC.

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	171100000X	Acupuncturist	720	CO

General Provider Information

NPI Number	:	1306809785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH EMILY WALTZMAN L.AC.

Provider Business Mailing Address
First Line	:	1936 S BROADWAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4005
Country	:	US
Telephone Number	:	303-777-2046
Fax Number	:	303-777-2047

Provider Business Practice Location Address
First Line	:	1936 S BROADWAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4005
Country	:	US
Telephone Number	:	303-777-2046
Fax Number	:	303-777-2047

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/08/2007

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