MEDICARE: CODY WATSON ,PT, DPT

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	3964	NE

General Provider Information

NPI Number	:	1316506363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY WATSON ,PT, DPT

Provider Business Mailing Address
First Line	:	3213 W NORTH FRONT ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-4026
Country	:	US
Telephone Number	:	308-395-7252
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 W NORTH FRONT ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-4026
Country	:	US
Telephone Number	:	308-395-7252
Fax Number	:

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

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	06/04/2024

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