Provider Demographics
NPI:1700081403
Name:WATERS, DARA ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DARA
Middle Name:ANN
Last Name:WATERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DARA
Other - Middle Name:ANN
Other - Last Name:OGLESBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4903 COUNTY ROAD P39
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-5077
Mailing Address - Country:US
Mailing Address - Phone:402-660-7289
Mailing Address - Fax:
Practice Address - Street 1:880 PARK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NE
Practice Address - Zip Code:68059-6845
Practice Address - Country:US
Practice Address - Phone:402-253-3079
Practice Address - Fax:402-253-2631
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2561OtherSTATE LICENSE