Provider Demographics
NPI:1063775575
Name:WATSON, ARMAND (PTA)
Entity type:Individual
Prefix:
First Name:ARMAND
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 MILLIKEN AVE APT 8214
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8517
Mailing Address - Country:US
Mailing Address - Phone:909-420-5751
Mailing Address - Fax:909-360-1682
Practice Address - Street 1:9200 MILLIKEN AVE APT 8214
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8517
Practice Address - Country:US
Practice Address - Phone:909-420-5751
Practice Address - Fax:909-360-1682
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30380225700000X
CAPTA48592225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist