Healthcare Provider Details

I. General information

NPI: 1376216978
Provider Name (Legal Business Name): EMILY K WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 31ST ST S STE A
ARLINGTON VA
22206-1663
US

IV. Provider business mailing address

4900 31ST ST S STE A
ARLINGTON VA
22206-1663
US

V. Phone/Fax

Practice location:
  • Phone: 703-340-4325
  • Fax:
Mailing address:
  • Phone: 703-340-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019014295
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: