Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT19409 | FL |
NPI | 1043331168 |
---|---|
Provider Name | Karin Colby Watson |
First Address | Viera, FL 32955-5185 |
Second Address | Viera, FL 32955-5185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |