MEDICARE: SALLIE WAITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTH619	AL

General Provider Information

NPI Number	:	1790884377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLIE WAITE

Provider Business Mailing Address
First Line	:	790 MONTGOMERY HWY
Second Line	:	SUITE 108
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-1872
Country	:	US
Telephone Number	:	205-822-7607
Fax Number	:	205-822-7614

Provider Business Practice Location Address
First Line	:	790 MONTGOMERY HWY
Second Line	:	SUITE 108
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-1872
Country	:	US
Telephone Number	:	205-822-7607
Fax Number	:	205-822-7614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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Directions to “ SALLIE WAITE ” Practice Location

Language	Start Address	Practice Location

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