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General NPI Number Information
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NPI Number | 1467882126
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Entity Type | Individual
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Provider Name | MANDY LYNN WATTS PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2013
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 88 E BONITA RD STE C
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City | CHULA VISTA
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State | CA
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Zip | 91910-3057
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Country | US
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Telephone | 619-230-0855
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 EASTGATE MALL STE 105
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City | SAN DIEGO
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State | CA
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Zip | 92121-1979
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Country | US
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Telephone | 185-877-5926
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Fax | 850-398-8482
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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 | PT32013
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT32013
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License Number State | FL
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