Provider Demographics
NPI:1952397465
Name:WATERS, TIMOTHY (BSC (PHYSIOTHERAPY))
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:WATERS
Suffix:
Gender:M
Credentials:BSC (PHYSIOTHERAPY)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 MAUNAIHI PL
Mailing Address - Street 2:SUITE 808
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 1113
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-218-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist