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NPI Code Detail

MEDICARE: JESSICA SHANNON WATSON P.T.A.

MEDICARE: JESSICA SHANNON WATSON P.T.A.
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
1225200000XPhysical Therapy AssistantPTA22089FL

General Provider Information

NPI Number : 1508113754
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SHANNON WATSON P.T.A.
Provider Business Mailing Address
First Line : 463 SW MULESKINNER CT
Second Line :
City : LAKE CITY
State : FL
Zip : 32024-1133
Country : US
Telephone Number : 352-339-0872
Fax Number :
Provider Business Practice Location Address
First Line : 404 NW HALL OF FAME DR
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-4833
Country : US
Telephone Number : 386-755-3163
Fax Number : 386-755-3165
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2012
Last Update Date : 06/28/2026

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