Active NPI
Quincy X Waite, PT, DPT
- Physical Therapist
- Bala Cynwyd, PA
National Provider Identifier
1740896950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT028785
- Practice address
- 100 Presidential Blvd
Bala Cynwyd, PA 19004-1108 - Phone
- (610) 668-0904
- NPI assigned
- Sep 22, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT028785 | PA | Primary |
Addresses
Primary practice location
100 Presidential Blvd
Bala Cynwyd, PA 19004-1108
Mailing address
36 Peninsula CT
Bear, DE 19701-2379
Phone (302) 750-3023
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT028785 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600732800000",
"number": "1740896950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 PENINSULA CT",
"city": "BEAR",
"state": "DE",
"postal_code": "197012379",
"telephone_number": "302-750-3023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 PRESIDENTIAL BLVD",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190041108",
"telephone_number": "610-668-0904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAITE",
"first_name": "QUINCY",
"middle_name": "X",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-22",
"last_updated": "2020-09-22",
"certification_date": "2020-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT028785",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bala Cynwyd, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.