Healthcare Provider Details

I. General information

NPI: 1619991221
Provider Name (Legal Business Name): JOANNA MARIE WAITE M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GLAMORGAN ST STE 110
ALLIANCE OH
44601-2938
US

IV. Provider business mailing address

75 GLAMORGAN ST STE 110
ALLIANCE OH
44601-2938
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-2249
  • Fax: 330-821-9318
Mailing address:
  • Phone: 330-821-2249
  • Fax: 330-821-9318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-008153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: