Provider Demographics
NPI:1508165333
Name:WAITE, MEGAN LEA (PT)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:LEA
Last Name:WAITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MEGAN
Other - Middle Name:LEE
Other - Last Name:DAIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3000 WILLISTON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6082
Mailing Address - Country:US
Mailing Address - Phone:802-658-6092
Mailing Address - Fax:
Practice Address - Street 1:3000 WILLISTON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6082
Practice Address - Country:US
Practice Address - Phone:802-658-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0008272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist