Healthcare Provider Details

I. General information

NPI: 1114985074
Provider Name (Legal Business Name): JOHN THOMAS WATERS JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 AUDUBON VILLAGE DR
NORRISTOWN PA
19403-2262
US

IV. Provider business mailing address

2804 AUDUBON VILLAGE DR
NORRISTOWN PA
19403-2262
US

V. Phone/Fax

Practice location:
  • Phone: 610-676-0411
  • Fax: 610-676-0412
Mailing address:
  • Phone: 610-676-0411
  • Fax: 610-676-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007658L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001779A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: