Provider Demographics
NPI:1932436334
Name:WAITE REHAB & WELLNESS
Entity Type:Organization
Organization Name:WAITE REHAB & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:256-489-2704
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4161225100000X
ALPTH4164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790709400OtherNPI
1962737775OtherNPI