Healthcare Provider Details

I. General information

NPI: 1588581441
Provider Name (Legal Business Name): TAYLOR DAWN WATTERS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 LEWIS LN STE 104
HAVRE DE GRACE MD
21078-3752
US

IV. Provider business mailing address

808 CREEK RD
ESSEX MD
21221-5806
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-8530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: