Healthcare Provider Details

I. General information

NPI: 1952235467
Provider Name (Legal Business Name): LAURA WATERMAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTVIEW PARK PL
KALISPELL MT
59901-3074
US

IV. Provider business mailing address

100 WESTVIEW PARK PL
KALISPELL MT
59901-3074
US

V. Phone/Fax

Practice location:
  • Phone: 406-393-2473
  • Fax: 406-393-2475
Mailing address:
  • Phone: 406-393-2473
  • Fax: 406-393-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPRD-PT-LIC-31693
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: