Provider Demographics
NPI:1316832918
Name:WATERS HALE, SHAE CHRISTINE (DPT, PT)
Entity type:Individual
Prefix:
First Name:SHAE
Middle Name:CHRISTINE
Last Name:WATERS HALE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 CARDINAL LOOP
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1262
Mailing Address - Country:US
Mailing Address - Phone:949-554-4299
Mailing Address - Fax:949-554-4299
Practice Address - Street 1:8750 TALLON LN NE STE C
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6608
Practice Address - Country:US
Practice Address - Phone:360-456-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT.PT.61639247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist