Individual
ANDREA WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
2209 GENESEE ST, UTICA, NY 13501-5930
(315) 801-8100
Mailing address
2209 GENESEE ST, UTICA, NY 13501-5930
(315) 801-8100
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
038985-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00313539
—
NY
05
—
01815443
—
NY
Enumeration date
09/01/2015
Last updated
03/26/2020
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