Healthcare Provider Details

I. General information

NPI: 1144935784
Provider Name (Legal Business Name): JARRED WAITE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 EAST OLD US 12
CHELSEA MI
48188
US

IV. Provider business mailing address

3075 W CLARK RD STE 200
YPSILANTI MI
48197-1103
US

V. Phone/Fax

Practice location:
  • Phone: 734-593-6370
  • Fax:
Mailing address:
  • Phone: 734-528-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: