Provider Demographics
NPI:1619991221
Name:WAITE, JOANNA MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MARIE
Last Name:WAITE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 GLAMORGAN ST
Mailing Address - Street 2:STE 110
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2938
Mailing Address - Country:US
Mailing Address - Phone:330-821-2249
Mailing Address - Fax:330-821-9318
Practice Address - Street 1:75 GLAMORGAN ST
Practice Address - Street 2:STE 110
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2938
Practice Address - Country:US
Practice Address - Phone:330-821-2249
Practice Address - Fax:330-821-9318
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-008153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2703855Medicaid
OH2703855Medicaid