Healthcare Provider Details

I. General information

NPI: 1568470201
Provider Name (Legal Business Name): CARRIE S WATERS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 COUNTRY CLUB RD SUITE 150
EUGENE OR
97401-6044
US

IV. Provider business mailing address

3599 SPRING BLVD
EUGENE OR
97405-4446
US

V. Phone/Fax

Practice location:
  • Phone: 541-895-5913
  • Fax: 541-895-5941
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5097
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: