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General NPI Number Information
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NPI Number | 1003085457
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Entity Type | Individual
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Provider Name | TAYLOR A WATERS PT,DPT
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Gender | Female
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 224 W D. L. INGRAM AVENUE BLDG 1408
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone | 540-692-4484
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Fax |
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Provider Business Mailing Address
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Address Line | 1051 SR 311 TRLR 21
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City | CLOVIS
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State | NM
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Zip | 88101-1294
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305205357
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License Number State | VA
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