Provider Demographics
NPI:1972538858
Name:WAITE, JANICE LOUISE (PT)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:LOUISE
Last Name:WAITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:WILBANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5521 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3337
Mailing Address - Country:US
Mailing Address - Phone:208-853-6220
Mailing Address - Fax:208-853-0554
Practice Address - Street 1:5521 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-3337
Practice Address - Country:US
Practice Address - Phone:208-853-6220
Practice Address - Fax:208-853-0554
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID091PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist