Provider Demographics
NPI:1154384915
Name:WAELTI, LENORA MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:LENORA
Middle Name:MARIE
Last Name:WAELTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SE DERBY ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2402
Mailing Address - Country:US
Mailing Address - Phone:509-334-4069
Mailing Address - Fax:
Practice Address - Street 1:1620 SE SUMMIT CT
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5519
Practice Address - Country:US
Practice Address - Phone:509-334-4069
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007527225100000X
IDPT-1745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist