Individual
DR. LARA LAMASTUS WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT PT
Contact information
Practice address
2474 E JOYCE BLVD STE 2, FAYETTEVILLE, AR 72703-4932
(795) 218-3264
Mailing address
2474 E JOYCE BLVD STE 2, FAYETTEVILLE, AR 72703-4932
(479) 521-8326
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2865
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157684721
—
AR
01
—
5Y801
BCBS
AR
Enumeration date
08/14/2006
Last updated
08/13/2024
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