MEDICARE: KAITLIN NICOLE WATCHEY 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	12594	AZ

General Provider Information

NPI Number	:	1427598879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN NICOLE WATCHEY DPT

Provider Business Mailing Address
First Line	:	PO BOX 31001-0747
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-0747
Country	:	US
Telephone Number	:	800-421-1965
Fax Number	:	916-773-1481

Provider Business Practice Location Address
First Line	:	6246 E PIMA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3156
Country	:	US
Telephone Number	:	520-712-5088
Fax Number	:	916-773-0586

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

Provider Enumeration Date	:	03/05/2017
Last Update Date	:	03/05/2017

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