Healthcare Provider Details

I. General information

NPI: 1942389861
Provider Name (Legal Business Name): TODD ALLEN WATSON DPT, OCS, FAAOMPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 SAND HILL RD SUITE 1
CANDLER NC
28715-8938
US

IV. Provider business mailing address

9 CADDIS CT
CANDLER NC
28715-6905
US

V. Phone/Fax

Practice location:
  • Phone: 828-418-1050
  • Fax:
Mailing address:
  • Phone: 828-665-1291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number7917
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7917
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: