MEDICARE: THE STRITTMATTER CENTER FOR WELLNESS, PLLC

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	207QA0505X	Adult Medicine Physician	K5411	TX

General Provider Information

NPI Number	:	1215339320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE STRITTMATTER CENTER FOR WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	1405 N ELM ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-3089
Country	:	US
Telephone Number	:	940-387-6387
Fax Number	:	940-387-6377

Provider Business Practice Location Address
First Line	:	1405 N ELM ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-3089
Country	:	US
Telephone Number	:	940-387-6387
Fax Number	:	940-387-6377

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	MARLA STRITTMATTER
Credential	:	MD
Telephone Number	:	940-367-7316

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	09/19/2014

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