Healthcare Provider Details

I. General information

NPI: 1861788150
Provider Name (Legal Business Name): JARRED SCOTT WATSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5827 HIGHWAY 90
MILTON FL
32583-1763
US

IV. Provider business mailing address

2065 AIRPORT BLVD SUITE 300
PENSACOLA FL
32504-5931
US

V. Phone/Fax

Practice location:
  • Phone: 850-983-8583
  • Fax: 850-983-8973
Mailing address:
  • Phone: 850-477-6966
  • Fax: 850-477-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: