MEDICARE: MS. TAMARA MARSHALL MARENICK 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	10226	NC

General Provider Information

NPI Number	:	1588797377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA MARSHALL MARENICK PT

Provider Business Mailing Address
First Line	:	2951 LOG BRIDGE RD
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8232
Country	:	US
Telephone Number	:	336-841-1254
Fax Number	:

Provider Business Practice Location Address
First Line	:	1795 WESTCHESTER DR
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27262-7008
Country	:	US
Telephone Number	:	336-888-4608
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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