Healthcare Provider Details

I. General information

NPI: 1467381129
Provider Name (Legal Business Name): NATALIA JOHANNA WATERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 S JEFFERSON ST
MONTICELLO FL
32344-1652
US

IV. Provider business mailing address

4621 DEEP CREEK TER
PARRISH FL
34219-2917
US

V. Phone/Fax

Practice location:
  • Phone: 850-997-7269
  • Fax:
Mailing address:
  • Phone: 850-218-2597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number014259
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA26805
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPRD-PTA-LIC-35127
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: