Provider Demographics
NPI:1134610520
Name:WAITE, CHANCES AMELIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHANCES
Middle Name:AMELIA
Last Name:WAITE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-8907
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:5022 OLD GODSEY LN STE 3
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6604
Practice Address - Country:US
Practice Address - Phone:423-870-3573
Practice Address - Fax:423-870-3574
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013437225100000X
TN12675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist