Healthcare Provider Details

I. General information

NPI: 1578697389
Provider Name (Legal Business Name): PATRICIA A WATSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 WAYSIDE RD
NEPTUNE NJ
07753-2735
US

IV. Provider business mailing address

9 COLUMBUS DR
MONMOUTH BEACH NJ
07750-1003
US

V. Phone/Fax

Practice location:
  • Phone: 732-922-6618
  • Fax: 732-922-6619
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA05505
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: