Provider Demographics
NPI:1285061382
Name:WATSON, JULIE WILDER (DPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:WILDER
Last Name:WATSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5428 212TH ST SW APT C204
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-6005
Mailing Address - Country:US
Mailing Address - Phone:206-605-4125
Mailing Address - Fax:
Practice Address - Street 1:3330 MONTE VILLA PKWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8972
Practice Address - Country:US
Practice Address - Phone:425-408-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT603679672251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics