MEDICARE: MARIAN ELIZABETH WALDIE 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	172M00000X	Mechanotherapist	33.16496	OH

General Provider Information

NPI Number	:	1760775126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN ELIZABETH WALDIE LMT

Provider Business Mailing Address
First Line	:	1840 ZOLLINGER RD STE A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2850
Country	:	US
Telephone Number	:	614-270-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 ZOLLINGER RD STE A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2850
Country	:	US
Telephone Number	:	614-270-8080
Fax Number	:

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

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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