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General NPI Number Information
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NPI Number | 1659022465
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Entity Type | Individual
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Provider Name | SHELBY JO WATERS
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Gender | Female
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 232 BRITE RD
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City | CIBOLO
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State | TX
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Zip | 78108-3899
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Country | US
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Telephone | 210-566-1269
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Fax |
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Provider Business Mailing Address
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Address Line | 10419 RINDERFARM CT
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City | NEW BRAUNFELS
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State | TX
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Zip | 78132-3879
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Country | US
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Telephone | 903-722-0982
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2143312
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License Number State | TX
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