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NPI Code Detail

MEDICARE: MRS. GWYNNE FORREST WATERS DPT

MEDICARE: MRS. GWYNNE FORREST WATERS DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5501002715MI

General Provider Information

NPI Number : 1891757993
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GWYNNE FORREST WATERS DPT
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-350-2644
Fax Number : 586-541-3735
Provider Business Practice Location Address
First Line : 281 ENTERPRISE CT STE 200
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-0311
Country : US
Telephone Number : 248-322-5280
Fax Number : 248-333-1915
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2006
Last Update Date : 01/23/2025

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