| Doctor Name: | FORREST L (BEN) WAIDE |
| NPI Number: | 1053300277 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, OCS, CHT |
| License Number: | 10011030054 |
| Business Practice Address: | 100 Ymca Dr Suite 5 Madisonville, KY - 424319000 |
| Business Phone Number: | 2708249227 |
| Business Fax Number: | 2708249206 |
| Mailing Address: | 100 Ymca Dr, Suite 5 MADISONVILLE |
| State: | KY |
| Postal Code: | 424319000 |
| Phone Number: | 2708249227 |
| Fax Number: | 2708249206 |
| NPI Enumeration Date: | 10/20/2005 |
| NPI Last Update Date: | 05/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251H1200X |
| License Number: | 10011030054 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Hand |
| Taxonomy Definition: | |