MEDICARE: DR. JEFFREY ALAN WALDRON DPT

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	2251X0800X	Orthopedic Physical Therapist	PT00008858	WA

General Provider Information

NPI Number	:	1396793667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY ALAN WALDRON DPT

Provider Business Mailing Address
First Line	:	21009 76TH AVE W
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7126
Country	:	US
Telephone Number	:	425-672-2910
Fax Number	:	425-778-1872

Provider Business Practice Location Address
First Line	:	21009 76TH AVE W
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7126
Country	:	US
Telephone Number	:	425-672-2910
Fax Number	:	425-778-1872

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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