Provider Demographics
NPI:1235456518
Name:WAITS, WESLEY B
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:B
Last Name:WAITS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 MAYSVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9767
Mailing Address - Country:US
Mailing Address - Phone:859-499-4351
Mailing Address - Fax:859-499-4321
Practice Address - Street 1:624 MAYSVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9767
Practice Address - Country:US
Practice Address - Phone:859-499-4351
Practice Address - Fax:859-499-4321
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT005593225100000X
OHPT011932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist