MEDICARE: MR. GEORGE WATSON

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		CA

General Provider Information

NPI Number	:	1952788127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE WATSON

Provider Business Mailing Address
First Line	:	64 GOLDEN HINDE BLVD
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-3817
Country	:	US
Telephone Number	:	415-305-9260
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 40TH STREET WAY
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5612
Country	:	US
Telephone Number	:	510-658-2041
Fax Number	:

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

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	01/18/2016

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Directions to “ MR. GEORGE WATSON ” Practice Location

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