Provider Demographics
NPI:1881941995
Name:WAITE, BRIAN ALLEN (DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALLEN
Last Name:WAITE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 AIRPORT EXCHANGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-3117
Mailing Address - Country:US
Mailing Address - Phone:859-647-6228
Mailing Address - Fax:859-372-6350
Practice Address - Street 1:1825 AIRPORT EXCHANGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-3117
Practice Address - Country:US
Practice Address - Phone:859-647-6228
Practice Address - Fax:859-372-6350
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist