Jeffrie Glenn Waters, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

9195 Issued in CA

Practice address

1685 Shaffer Rd
Atwater, CA 95301-4456

Phone

(209) 357-3420

NPI assigned

Oct 30, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383091200000",
    "number": "1821426859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 PEDRAS RD APT E203",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953822347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1685 SHAFFER RD",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953014456",
            "telephone_number": "209-357-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "JEFFRIE",
        "middle_name": "GLENN",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-30",
        "last_updated": "2013-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "9195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPIST ASSISTANT LICENSE NUMBER",
            "identifier": "9195",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Atwater, CA
• Providers in Atwater, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.