=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467381129
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIA JOHANNA WATERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2026
-----------------------------------------------------
Last Update Date | 05/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1656 S JEFFERSON ST
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32344-1652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-997-7269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4621 DEEP CREEK TER
-----------------------------------------------------
City | PARRISH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34219-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-218-2597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 014259
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PTA26805
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PRD-PTA-LIC-35127
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------