Healthcare Provider Details

I. General information

NPI: 1497724538
Provider Name (Legal Business Name): KELLY A WATSON MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 FM 2100 RD STE 4
CROSBY TX
77532-9162
US

IV. Provider business mailing address

14700 FM 2100 RD STE 4
CROSBY TX
77532-9162
US

V. Phone/Fax

Practice location:
  • Phone: 281-328-8346
  • Fax: 281-326-8347
Mailing address:
  • Phone: 281-328-8346
  • Fax: 281-328-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1185170
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: