Provider Demographics
NPI:1902235435
Name:WATERS, THERESE MARIE SCHROEDER (PT)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:MARIE SCHROEDER
Last Name:WATERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7739 OUTER DR S
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9029
Mailing Address - Country:US
Mailing Address - Phone:231-633-4390
Mailing Address - Fax:
Practice Address - Street 1:4211 WESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9331
Practice Address - Country:US
Practice Address - Phone:231-409-8758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501300358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist