Healthcare Provider Details

I. General information

NPI: 1174941538
Provider Name (Legal Business Name): JAMES WATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 WADSWORTH BLVD STE A
ARVADA CO
80003-0922
US

IV. Provider business mailing address

8725 WADSWORTH BLVD STE A
ARVADA CO
80003-0922
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-7298
  • Fax:
Mailing address:
  • Phone: 303-425-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0005646
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: