Provider Demographics
NPI:1750627360
Name:WATERHOUSE, DAWN LYNETTE (PT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:LYNETTE
Last Name:WATERHOUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:LYNETTE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3400 CALLOWAY DR STE 603
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2514
Mailing Address - Country:US
Mailing Address - Phone:661-873-7975
Mailing Address - Fax:661-616-9199
Practice Address - Street 1:1800 WESTWIND DR STE 500
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:661-616-9199
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist