Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003181850 |
---|---|
Provider Name | Harold Watts |
First Address | Louisville, KY 40202-1423 |
Second Address | Louisville, KY 40220-1333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2012 |
Last Update Date | 20/09/2012 |