MEDICARE: EDWINA CHRISTINE WEXLER 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	174400000X	Specialist	MA55887	FL

General Provider Information

NPI Number	:	1275777252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWINA CHRISTINE WEXLER LMT

Provider Business Mailing Address
First Line	:	PO BOX 14144
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33733-4144
Country	:	US
Telephone Number	:	727-331-7435
Fax Number	:

Provider Business Practice Location Address
First Line	:	5915 MEMORIAL HWY
Second Line	:	STE B
City	:	TAMPA
State	:	FL
Zip	:	33615-5008
Country	:	US
Telephone Number	:	727-331-7435
Fax Number	:

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

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

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