Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 07243 | OH |
NPI | 1386606382 |
---|---|
Provider Name | Mr. Anthony Wayne Watson |
First Address | Oxford, OH 45056-2129 |
Second Address | Oxford, OH 45056-2129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 08/07/2007 |