Provider Demographics
NPI:1316689722
Name:WAITER, BRIAN SCOTT
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:SCOTT
Last Name:WAITER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GOLDFINCH LN
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8859
Mailing Address - Country:US
Mailing Address - Phone:717-645-6588
Mailing Address - Fax:
Practice Address - Street 1:308 GOLDFINCH LN
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-8859
Practice Address - Country:US
Practice Address - Phone:717-645-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer