Basic Information
| Provider Information | |||||||||
| NPI: | 1881941995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAITE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1825 AIRPORT EXCHANGE BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ERLANGER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410183117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596476228 | ||||||||
| FaxNumber: | 8593726350 | ||||||||
| Practice Location | |||||||||
| Address1: | 1825 AIRPORT EXCHANGE BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ERLANGER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410183117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596476228 | ||||||||
| FaxNumber: | 8593726350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2012 | ||||||||
| LastUpdateDate: | 08/08/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 006078 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.