Provider Demographics
NPI:1306091269
Name:WADE, MARIAN H (PT)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:H
Last Name:WADE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:H
Other - Last Name:SAMELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:50 MORNINGSIDE DR
Mailing Address - Street 2:#32
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1756
Mailing Address - Country:US
Mailing Address - Phone:212-866-0648
Mailing Address - Fax:
Practice Address - Street 1:50 MORNINGSIDE DR
Practice Address - Street 2:#32
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1739
Practice Address - Country:US
Practice Address - Phone:212-866-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013256-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist