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NPI Code Detail

MEDICARE: MR. MICHAEL BRANDON WATERS LPT

MEDICARE: MR. MICHAEL BRANDON WATERS LPT
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 Therapist8208NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1017PXOTHERNCBCBS

General Provider Information

NPI Number : 1912948084
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL BRANDON WATERS LPT
Provider Business Mailing Address
First Line : 247 OAK STREET EXTENSION
Second Line : SUITE 145
City : FOREST CITY
State : NC
Zip : 28043-3585
Country : US
Telephone Number : 828-245-5003
Fax Number : 828-245-5798
Provider Business Practice Location Address
First Line : 247 OAK ST EXTENSION
Second Line : SUITE 145
City : FOREST CITY
State : NC
Zip : 28043-3585
Country : US
Telephone Number : 828-245-5003
Fax Number : 828-245-5798
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 07/08/2007

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