Individual
FORREST L (BEN) WAIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, OCS, CHT
Contact information
Practice address
2228 ANTON RD, MADISONVILLE, KY 42431-7700
(270) 399-1776
(270) 440-2007
Mailing address
2228 ANTON RD, MADISONVILLE, KY 42431-7700
(270) 399-1776
(270) 440-2007
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001533
KY
2251H1200X
Hand Physical Therapist
10011030054
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000477215
ANTHEM BCBS FACET #
KY
Enumeration date
10/20/2005
Last updated
02/27/2017
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