Healthcare Provider Details

I. General information

NPI: 1154076354
Provider Name (Legal Business Name): RACHEL WATKINS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 5TH ST
BROOKINGS OR
97415-9702
US

IV. Provider business mailing address

1625 SAN BONIFACIO ARC
LAS CRUCES NM
88005-4006
US

V. Phone/Fax

Practice location:
  • Phone: 541-412-2000
  • Fax:
Mailing address:
  • Phone: 719-304-9568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9913
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: