Provider Demographics
NPI:1609069467
Name:WAITE, MARCY B (PTA)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:B
Last Name:WAITE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 HONEY RUN DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-9449
Mailing Address - Country:US
Mailing Address - Phone:502-216-9302
Mailing Address - Fax:
Practice Address - Street 1:1770 BARLEY RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-2223
Practice Address - Country:US
Practice Address - Phone:502-899-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01970225200000X
PATE007893225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant