Provider Demographics
NPI:1790709400
Name:WAITE, SCOTT A (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:WAITE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7915 HIGHWAY 72 W
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9561
Mailing Address - Country:US
Mailing Address - Phone:256-489-2704
Mailing Address - Fax:
Practice Address - Street 1:7915 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9561
Practice Address - Country:US
Practice Address - Phone:256-489-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529928640Medicaid
AL51532259OtherBLUE CROSS BLUE SHIELD
631283106OtherTRICARE
631283106OtherTRICARE
P46825Medicare UPIN