Provider Demographics
NPI:1952733552
Name:WAITE, CHRISTINE F (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:F
Last Name:WAITE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:FRANCES
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E TERRY DR BULIDING 63 FLOOR 2
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-6408
Mailing Address - Country:US
Mailing Address - Phone:208-282-2590
Mailing Address - Fax:833-499-1813
Practice Address - Street 1:1400 E TERRY DR BULIDING 63 FLOOR 2
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-6408
Practice Address - Country:US
Practice Address - Phone:208-282-2590
Practice Address - Fax:833-499-1813
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT 3222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist