Healthcare Provider Details

I. General information

NPI: 1780511691
Provider Name (Legal Business Name): KELSEY WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 SMITH CHAPEL RD
MOUNT OLIVE NC
28365-1917
US

IV. Provider business mailing address

4301 ANCHOR PLAZA PKWY STE 240
TAMPA FL
33634-7522
US

V. Phone/Fax

Practice location:
  • Phone: 919-658-9522
  • Fax:
Mailing address:
  • Phone: 866-425-5768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: