MEDICARE: KELSEY WATSON

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	225200000X	Physical Therapy Assistant		NC

General Provider Information

NPI Number	:	1780511691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY WATSON

Provider Business Mailing Address
First Line	:	4301 ANCHOR PLAZA PKWY STE 240
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-7522
Country	:	US
Telephone Number	:	866-425-5768
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 SMITH CHAPEL RD
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1917
Country	:	US
Telephone Number	:	919-658-9522
Fax Number	:

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

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/07/2026

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Directions to “ KELSEY WATSON ” Practice Location

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