Healthcare Provider Details

I. General information

NPI: 1265749931
Provider Name (Legal Business Name): ASHLYN EMILY WATSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 W BAY TO BAY BLVD SUITE 100
TAMPA FL
33629-8172
US

IV. Provider business mailing address

2907 W BAY TO BAY BLVD SUITE 100
TAMPA FL
33629-8172
US

V. Phone/Fax

Practice location:
  • Phone: 813-250-1208
  • Fax:
Mailing address:
  • Phone: 813-250-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1198257
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: