MEDICARE: MR. TIMOTHY WATERS B.SC (PHYSIOTHERAPY)

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	225100000X	Physical Therapist	1996	HI

General Provider Information

NPI Number	:	1952397465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY WATERS B.SC (PHYSIOTHERAPY)

Provider Business Mailing Address
First Line	:	1031 MAUNAIHI PL
Second Line	:	SUITE 808
City	:	HONOLULU
State	:	HI
Zip	:	96822-3479
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 KAPIOLANI BLVD
Second Line	:	SUITE 1113
City	:	HONOLULU
State	:	HI
Zip	:	96814-4402
Country	:	US
Telephone Number	:	808-218-3660
Fax Number	:

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	10/10/2008

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