MEDICARE: PATRICIA N WATSON BA,MSPT

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	225100000X	Physical Therapist	11-03119	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11-03119	OTHER	KS	KS BOEARD OF HEALLING ART

General Provider Information

NPI Number	:	1164450706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA N WATSON BA,MSPT

Provider Business Mailing Address
First Line	:	5000 W 95TH ST
Second Line	:	SUITE 100
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207-3364
Country	:	US
Telephone Number	:	913-438-8000
Fax Number	:	913-438-8008

Provider Business Practice Location Address
First Line	:	5000 W 95TH ST
Second Line	:	SUITE 100
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207-3364
Country	:	US
Telephone Number	:	913-438-8000
Fax Number	:	913-438-8008

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/09/2007

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