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General NPI Number Information
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NPI Number | 1891268520
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Entity Type | Individual
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Provider Name | STEFANIE WATTS PT, DPT, NCS
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Gender | Female
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 1327 GRANDIN RD SW # 243
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City | ROANOKE
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State | VA
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Zip | 24015-2349
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Country | US
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Telephone | 540-526-8489
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 JEANETTE AVE
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City | VINTON
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State | VA
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Zip | 24179-1808
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305206596
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License Number State | VA
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