MEDICARE: MARK A WATSON PT

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	225100000X	Physical Therapist	PT011181	PA
2	225100000X	Physical Therapist	P11928	NC

General Provider Information

NPI Number	:	1285618884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A WATSON PT

Provider Business Mailing Address
First Line	:	4112 SPRING GARDEN ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1684
Country	:	US
Telephone Number	:	336-294-0910
Fax Number	:

Provider Business Practice Location Address
First Line	:	4112 SPRING GARDEN ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1684
Country	:	US
Telephone Number	:	336-294-0910
Fax Number	:

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	05/01/2025

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Directions to “ MARK A WATSON PT” Practice Location

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