Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305205357 | VA |
NPI | 1003085457 |
---|---|
Provider Name | Ms. Taylor A Waters |
First Address | Vienna, VA 22180-4734 |
Second Address | Vienna, VA 22180-4734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2008 |
Last Update Date | 28/12/2012 |