Provider Demographics
NPI:1700014123
Name:WAID, MARNENE JEAN (CMT)
Entity Type:Individual
Prefix:MS
First Name:MARNENE
Middle Name:JEAN
Last Name:WAID
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MS
Other - First Name:MARNENE
Other - Middle Name:JEAN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:15 ST. ANDREWS RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-9594
Mailing Address - Country:US
Mailing Address - Phone:209-772-0550
Mailing Address - Fax:209-772-0550
Practice Address - Street 1:15 SAINT ANDREWS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-9295
Practice Address - Country:US
Practice Address - Phone:209-772-0550
Practice Address - Fax:209-772-0550
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist