MEDICARE: GREGORY LEE WAITE PT, DPT

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	PT008555L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831178953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY LEE WAITE PT, DPT

Provider Business Mailing Address
First Line	:	991 ROUTE 19N, SUITE E
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441
Country	:	US
Telephone Number	:	814-796-3400
Fax Number	:	814-796-8533

Provider Business Practice Location Address
First Line	:	991 ROUTE 19N, SUITE E
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441
Country	:	US
Telephone Number	:	814-796-3400
Fax Number	:	814-796-8533

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	06/26/2014

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