MEDICARE: ALLISON GOLD WATSON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	60945842	WA

General Provider Information

NPI Number	:	1063032548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON GOLD WATSON PTA

Provider Business Mailing Address
First Line	:	509 OLIVE WAY STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-3263
Country	:	US
Telephone Number	:	206-860-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 OLIVE WAY STE 200
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-3263
Country	:	US
Telephone Number	:	206-860-2211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	04/24/2020

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