Healthcare Provider Details

I. General information

NPI: 1770231045
Provider Name (Legal Business Name): LARAVEN S WATERMAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HARRIS CT BLDG T
MONTEREY CA
93940-5750
US

IV. Provider business mailing address

5 HARRIS CT BLDG T 102
MONTEREY CA
93940-5750
US

V. Phone/Fax

Practice location:
  • Phone: 831-372-3579
  • Fax: 831-372-3779
Mailing address:
  • Phone: 831-372-3579
  • Fax: 831-372-3779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5091
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT41456
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: