MEDICARE: SHEILA WATKINS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	13192	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13192	OTHER	CO	MEDICARE

General Provider Information

NPI Number	:	1033541412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA WATKINS PTA

Provider Business Mailing Address
First Line	:	3353 W BIJOU ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-1424
Country	:	US
Telephone Number	:	719-310-6050
Fax Number	:

Provider Business Practice Location Address
First Line	:	3353 W BIJOU ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-1424
Country	:	US
Telephone Number	:	719-310-6050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/07/2013

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