MEDICARE: AUDREY M WALDRON P.T.

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	3455	CO

General Provider Information

NPI Number	:	1700883782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY M WALDRON P.T.

Provider Business Mailing Address
First Line	:	5387 MANHATTAN CIR
Second Line	:	SUITE 100A
City	:	BOULDER
State	:	CO
Zip	:	80303-4284
Country	:	US
Telephone Number	:	303-543-7878
Fax Number	:	303-543-7676

Provider Business Practice Location Address
First Line	:	5387 MANHATTAN CIR
Second Line	:	SUITE 100A
City	:	BOULDER
State	:	CO
Zip	:	80303-4284
Country	:	US
Telephone Number	:	303-543-7878
Fax Number	:	303-543-7676

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/09/2007

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