Lara Lamastus Waite, DPT PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT2865 Issued in AR

Practice address

2474 E Joyce Blvd Ste 2
Fayetteville, AR 72703-4932

Phone

(795) 218-3264

NPI assigned

Aug 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hope for Tomorrow Pediatric Foundation

  • Occupational Therapist
  • Farmington, AR
  • NPI 1427166768
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1801809553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2474 E JOYCE BLVD STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034932",
            "telephone_number": "479-521-8326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2474 E JOYCE BLVD STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034932",
            "telephone_number": "795-218-3264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAITE",
        "first_name": "LARA",
        "middle_name": "LAMASTUS",
        "name_prefix": "Dr.",
        "credential": "DPT PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT2865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157684721",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5Y801",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia D Wagner
• Lindsey Lea Wagner, LCSW
• Tommy Wagner III
• Madeline Wagnon, M.S., CFY-SLP
• Rachel Elizabeth Wagoner
• Allie Frances Wakefield, LPEI
• Wal-Mart Stores, Inc
• Wal-Mart Stores, Inc.
• Wal-Mart Stores, Inc.
• Emily Rodgers Waldorf, P.T.

• Physical Therapist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; 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.