Healthcare Provider Details

I. General information

NPI: 1922825678
Provider Name (Legal Business Name): COLLIN XAVIER WATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 I ST NW
WASHINGTON DC
20001-1425
US

IV. Provider business mailing address

10605 WOOD POINTE TER
GLENN DALE MD
20769-2123
US

V. Phone/Fax

Practice location:
  • Phone: 202-841-5127
  • Fax:
Mailing address:
  • Phone: 202-841-5127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: