MEDICARE: MR. TIMOTHY RAY WALENDZIK LMT

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	171W00000X	Contractor	MA 47444	FL

General Provider Information

NPI Number	:	1114078961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY RAY WALENDZIK LMT

Provider Business Mailing Address
First Line	:	1248 JASMINE LAKE DR
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-5264
Country	:	US
Telephone Number	:	727-934-2981
Fax Number	:

Provider Business Practice Location Address
First Line	:	13911 LAKESHORE BLVD
Second Line	:	UNIT 102
City	:	HUDSON
State	:	FL
Zip	:	34667-7102
Country	:	US
Telephone Number	:	727-869-3803
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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