Active NPI
Taylor A Waters, PT,DPT
- Physical Therapist
- Cannon Afb, NM
National Provider Identifier
1003085457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305205357
- Practice address
- 224 W D. L. Ingram Avenue
BLDG 1408
Cannon Afb, NM 88103 - Phone
- (540) 692-4484
- NPI assigned
- Feb 29, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305205357 | VA | Primary |
Addresses
Primary practice location
224 W D. L. Ingram Avenue
BLDG 1408
Cannon Afb, NM 88103
Mailing address
1051 Sr 311 TRLR 21
Clovis, NM 88101-1294
Other practice location 1
501 Church St NE
Ste 105
Vienna, VA 22180-4734
Phone (703) 938-8585
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700092800000",
"number": "1003085457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1051 SR 311 TRLR 21",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881011294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "224 W D. L. INGRAM AVENUE",
"address_2": "BLDG 1408",
"city": "CANNON AFB",
"state": "NM",
"postal_code": "88103",
"telephone_number": "540-692-4484"
}
],
"practiceLocations": [
{
"address_1": "501 Church St NE",
"address_2": "Ste 105",
"address_purpose": "LOCATION",
"city": "Vienna",
"state": "VA",
"postal_code": "221804734",
"country_code": "US",
"telephone_number": "703-938-8585",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WATERS",
"first_name": "TAYLOR",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PT,DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-29",
"last_updated": "2023-11-16",
"certification_date": "2023-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305205357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cannon Afb, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.