MEDICARE: ADAM WATERS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	06005114A	IN

General Provider Information

NPI Number	:	1811431851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM WATERS PTA

Provider Business Mailing Address
First Line	:	6437 HIGHWAY 62
Second Line	:
City	:	LANESVILLE
State	:	IN
Zip	:	47136-9438
Country	:	US
Telephone Number	:	812-225-1967
Fax Number	:

Provider Business Practice Location Address
First Line	:	871 PACER DR NW
Second Line	:
City	:	CORYDON
State	:	IN
Zip	:	47112-2145
Country	:	US
Telephone Number	:	812-738-0317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2016
Last Update Date	:	12/09/2016

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Directions to “ ADAM WATERS PTA” Practice Location

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