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NPI Code Detail

MEDICARE: MARNIE LYNN VANDEN NOVEN MS PT

MEDICARE: MARNIE LYNN VANDEN NOVEN MS PT
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
1225100000XPhysical Therapist9138TN

General Provider Information

NPI Number : 1417225103
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARNIE LYNN VANDEN NOVEN MS PT
Provider Business Mailing Address
First Line : 10 NEW KING ST
Second Line : SUITE 105
City : WHITE PLAINS
State : NY
Zip : 10604-1205
Country : US
Telephone Number : 914-390-9880
Fax Number : 914-390-9881
Provider Business Practice Location Address
First Line : 4206 STAMMER PL
Second Line :
City : NASHVILLE
State : TN
Zip : 37215-3302
Country : US
Telephone Number : 615-298-4555
Fax Number : 615-298-4555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2011
Last Update Date : 12/08/2011

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