Healthcare Provider Details

I. General information

NPI: 1821901323
Provider Name (Legal Business Name): JEFFERY LYNN WATSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 MC 18
TEXARKANA AR
71854-0906
US

IV. Provider business mailing address

2524 MC 18
TEXARKANA AR
71854-0906
US

V. Phone/Fax

Practice location:
  • Phone: 903-614-4373
  • Fax: 903-614-4444
Mailing address:
  • Phone: 903-614-4373
  • Fax: 903-614-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1143915
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: