MEDICARE: MARIAN SLAY 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	CP054084T	SC
2	225100000X	Physical Therapist	CP038476T	AZ
3	225100000X	Physical Therapist	009236	KY
4	225100000X	Physical Therapist	CP042605T	WA

General Provider Information

NPI Number	:	1083438717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN SLAY PT

Provider Business Mailing Address
First Line	:	343 PATCHEN DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4310
Country	:	US
Telephone Number	:	859-797-0306
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 VILLAGE CENTER BLVD STE 100
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6706
Country	:	US
Telephone Number	:	843-353-3460
Fax Number	:	843-353-3461

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

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	04/06/2026

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Directions to “ MARIAN SLAY PT” Practice Location

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