MEDICARE: JONATHAN WATERS

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
1	2251N0400X	Neurology Physical Therapist	PT43140	FL

General Provider Information

NPI Number	:	1922967702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN WATERS

Provider Business Mailing Address
First Line	:	1523 ELF STONE CT
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-5938
Country	:	US
Telephone Number	:	561-914-0989
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 E ROLLINS ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5502
Country	:	US
Telephone Number	:	407-303-8280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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