MEDICARE: MARITA GUILDERSON 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	MA11218	FL

General Provider Information

NPI Number	:	1376810762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITA GUILDERSON LMT

Provider Business Mailing Address
First Line	:	14253 NW 232ND ST
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-6855
Country	:	US
Telephone Number	:	386-454-3761
Fax Number	:

Provider Business Practice Location Address
First Line	:	14253 NW 232ND ST
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-6855
Country	:	US
Telephone Number	:	386-454-3761
Fax Number	:

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

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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Directions to “ MARITA GUILDERSON LMT” Practice Location

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