Healthcare Provider Details

I. General information

NPI: 1548380728
Provider Name (Legal Business Name): BETH E WATKINS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12720 BENT OAK CT
INDIANAPOLIS IN
46236-7380
US

IV. Provider business mailing address

12720 BENT OAK CT
INDIANAPOLIS IN
46236-7380
US

V. Phone/Fax

Practice location:
  • Phone: 317-345-9687
  • Fax: 317-823-8645
Mailing address:
  • Phone: 317-345-9687
  • Fax: 317-823-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05006252A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: