Provider Demographics
NPI:1811147507
Name:WANDER, ROBERT H (LMT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:H
Last Name:WANDER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 LOWESTONE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-4259
Mailing Address - Country:US
Mailing Address - Phone:614-488-3047
Mailing Address - Fax:
Practice Address - Street 1:4455 LOWESTONE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-4259
Practice Address - Country:US
Practice Address - Phone:614-488-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012252225700000X
FLMA 53620225700000X
OH33.010323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist