Provider Demographics
NPI:1396053435
Name:WALDO, MARNE RUTH (PT)
Entity type:Individual
Prefix:MRS
First Name:MARNE
Middle Name:RUTH
Last Name:WALDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41756 WALDO RD NE
Mailing Address - Street 2:
Mailing Address - City:KELLIHER
Mailing Address - State:MN
Mailing Address - Zip Code:56650-3212
Mailing Address - Country:US
Mailing Address - Phone:218-647-8477
Mailing Address - Fax:
Practice Address - Street 1:172 SUMMIT AVE W
Practice Address - Street 2:
Practice Address - City:BLACKDUCK
Practice Address - State:MN
Practice Address - Zip Code:56630-2140
Practice Address - Country:US
Practice Address - Phone:218-835-3425
Practice Address - Fax:218-835-3433
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist