Provider Demographics
NPI:1245836477
Name:WAITS, ALLISON (DPT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WAITS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22477 HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-7984
Mailing Address - Country:US
Mailing Address - Phone:708-834-4731
Mailing Address - Fax:
Practice Address - Street 1:3280 DAUPHIN ST STE A103
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4048
Practice Address - Country:US
Practice Address - Phone:251-459-8402
Practice Address - Fax:251-459-8403
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPT55045225100000X
IL070.025442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist