Provider Demographics
NPI:1851082143
Name:WAITE, JAYLYNN LEINAALA JITCHAKU (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JAYLYNN
Middle Name:LEINAALA JITCHAKU
Last Name:WAITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:JAYLYNN
Other - Middle Name:LEINAALA
Other - Last Name:JITCHAKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3848 S TRUCKEE WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3165
Mailing Address - Country:US
Mailing Address - Phone:808-557-0250
Mailing Address - Fax:
Practice Address - Street 1:12101 E 2ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8328
Practice Address - Country:US
Practice Address - Phone:720-588-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0025420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist