MEDICARE: MS. JENNIFER ROSE WATSON M.P.T.

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	2305202961	VA

General Provider Information

NPI Number	:	1669426714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ROSE WATSON M.P.T.

Provider Business Mailing Address
First Line	:	5301 PROVIDENCE RD
Second Line	:	SUITE 80
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4128
Country	:	US
Telephone Number	:	757-467-1900
Fax Number	:	757-467-7900

Provider Business Practice Location Address
First Line	:	5301 PROVIDENCE RD
Second Line	:	SUITE 80
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4128
Country	:	US
Telephone Number	:	757-467-1900
Fax Number	:	757-467-7900

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	12/02/2015

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