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General NPI Number Information
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NPI Number | 1124738414
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Entity Type | Individual
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Provider Name | IAN WATSON
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Gender | Male
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 1946 TOWN PARK BLVD
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City | UNIONTOWN
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State | OH
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Zip | 44685-8372
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Country | US
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Telephone | 330-896-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 492 EVERGREEN DR
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City | TALLMADGE
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State | OH
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Zip | 44278-1300
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Country | US
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Telephone | 330-962-9399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT019713
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License Number State | OH
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