Provider Demographics
NPI:1447481544
Name:WATSON, EDITH VERONICA (PTA)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:VERONICA
Last Name:WATSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 S BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WEBSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46555-9112
Mailing Address - Country:US
Mailing Address - Phone:574-518-2537
Mailing Address - Fax:
Practice Address - Street 1:829 S BLAINE STREET
Practice Address - Street 2:
Practice Address - City:NORTH WEBSTER
Practice Address - State:IN
Practice Address - Zip Code:46555-9112
Practice Address - Country:US
Practice Address - Phone:574-518-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008978A225200000X
SC1257225200000X
FLPTA21625225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant