Individual
MR. GREG A WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
304 S 1ST ST, SUITE A, SELAH, WA 98942-2005
(509) 697-5330
(509) 697-5355
Mailing address
304 S 1ST ST, SUITE A, SELAH, WA 98942-2005
(509) 697-5330
(509) 697-5355
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00010130
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0290142
LABOR & INDUSTRIES
WA
Enumeration date
10/24/2006
Last updated
02/28/2012
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