Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1481 | MS |
NPI | 1003140104 |
---|---|
Provider Name | Reneda S Watts-Anderson |
First Address | Ridgeland, MS 39157-5120 |
Second Address | Ridgeland, MS 39157-5120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2009 |
Last Update Date | 23/09/2009 |