Healthcare Provider Details

I. General information

NPI: 1528754215
Provider Name (Legal Business Name): JANEY CHARLENE GONZALES WATSON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANEY CHARLENE GONZALES ANGELES

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463646 STATE ROAD 200 STE 4
YULEE FL
32097-0303
US

IV. Provider business mailing address

PO BOX 949
ROME GA
30162-0949
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-4414
  • Fax: 904-261-4414
Mailing address:
  • Phone: 904-261-4414
  • Fax: 904-261-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT39892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: