Shan Eve Waid, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160009347 Issued in IL

Practice address

6901 N Galena Rd
Peoria, IL 61614-3193

Phone

(309) 692-4600

NPI assigned

Jan 1, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640995200000",
    "number": "1588325674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 COUNTY ROAD 650 N",
            "city": "SPARLAND",
            "state": "IL",
            "postal_code": "615659657",
            "telephone_number": "309-363-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 N GALENA RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143193",
            "telephone_number": "309-692-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAID",
        "first_name": "SHAN",
        "middle_name": "EVE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-01",
        "last_updated": "2022-01-01",
        "certification_date": "2022-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160009347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenny Wagner
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• Ellie Marie Waibel, LSW
• Madi Waibel
• Andrea Wainright, PTA
• Kathryn Leigh Waits, LMT
• Tonya S Wake, MT
• Christopher Robert Wakid, M.D.
• Wal-Mart Stores, Inc (Vision Center 30-1323)

• Physical Therapy Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.