Healthcare Provider Details

I. General information

NPI: 1720023518
Provider Name (Legal Business Name): NILDA WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

1591 SUNFLOWER CT
WINTER PARK FL
32792-6314
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-1354
  • Fax:
Mailing address:
  • Phone: 407-672-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: