Basic Information
| Provider Information | |||||||||
| NPI: | 1528157385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATERS | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.S.,P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 101 | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300240101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8338887868 | ||||||||
| FaxNumber: | 8338887868 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 EXCHANGE PL | ||||||||
| Address2: | SUITE 728 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100052701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124251060 | ||||||||
| FaxNumber: | 6465279021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 10/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 024977 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.