Active NPI
Tiffany Dawn Waters, PT
- Physical Therapist
- Jonesboro, LA
National Provider Identifier
1356964670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 04075
- Practice address
- 260 Lake Ridge TRL
Jonesboro, LA 71251-6621 - Phone
- (318) 245-4332
- NPI assigned
- May 20, 2020
- 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 | 04075 | LA | Primary |
Addresses
Primary practice location
260 Lake Ridge TRL
Jonesboro, LA 71251-6621
Mailing address
260 Lake Ridge TRL
Jonesboro, LA 71251-6621
Phone (318) 245-4332
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04075 | LA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589932800000",
"number": "1356964670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "260 LAKE RIDGE TRL",
"city": "JONESBORO",
"state": "LA",
"postal_code": "712516621",
"telephone_number": "318-245-4332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "260 LAKE RIDGE TRL",
"city": "JONESBORO",
"state": "LA",
"postal_code": "712516621",
"telephone_number": "318-245-4332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "TIFFANY",
"middle_name": "DAWN",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-20",
"last_updated": "2020-05-20",
"certification_date": "2020-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "LA",
"license": "04075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.