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NPI Code Detail

MEDICARE: NANCY JEAN WATT PTA

MEDICARE: NANCY JEAN WATT PTA
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 Assistant116878MO

General Provider Information

NPI Number : 1851509996
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY JEAN WATT PTA
Provider Business Mailing Address
First Line : 1300 SW SHAWNEE ST
Second Line :
City : BLUE SPRINGS
State : MO
Zip : 64015-5430
Country : US
Telephone Number : 816-228-3339
Fax Number :
Provider Business Practice Location Address
First Line : 111 NW MOCK AVE
Second Line :
City : BLUE SPRINGS
State : MO
Zip : 64014-2503
Country : US
Telephone Number : 816-228-5655
Fax Number : 816-228-8480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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