MEDICARE: ELIZABETH WALDNER 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
1	225100000X	Physical Therapist	PT00007253	WA

General Provider Information

NPI Number	:	1780737346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WALDNER PT

Provider Business Mailing Address
First Line	:	2442 NW MARKET ST
Second Line	:	P.O BOX 450
City	:	SEATTLE
State	:	WA
Zip	:	98107-4137
Country	:	US
Telephone Number	:	206-715-1884
Fax Number	:	206-783-0867

Provider Business Practice Location Address
First Line	:	4110 STONE WAY N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8000
Country	:	US
Telephone Number	:	206-715-1884
Fax Number	:	206-783-0867

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/22/2008

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