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NPI Code Detail

MEDICARE: MS. ALISHA NICOLE WATSON PTA

MEDICARE: MS. ALISHA NICOLE WATSON 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
1225200000XPhysical Therapy Assistant2068447TX

General Provider Information

NPI Number : 1164674693
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALISHA NICOLE WATSON PTA
Provider Business Mailing Address
First Line : 1960 N 79TH TER
Second Line :
City : KANSAS CITY
State : KS
Zip : 66112-2049
Country : US
Telephone Number : 913-530-4175
Fax Number :
Provider Business Practice Location Address
First Line : 3301 W PARK ROW BLVD
Second Line :
City : CORSICANA
State : TX
Zip : 75110-4846
Country : US
Telephone Number : 903-872-2455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2008
Last Update Date : 10/15/2008

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