Individual
MR. JEFFRIE GLENN WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1685 SHAFFER RD, ATWATER, CA 95301-4456
(209) 357-3420
Mailing address
1100 PEDRAS RD APT E203, TURLOCK, CA 95382-2347
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9195
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9195
PHYSICAL THERAPIST ASSISTANT LICENSE NUMBER
CA
Enumeration date
10/30/2013
Last updated
10/30/2013
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