Provider Demographics
NPI:1427329929
Name:WATSON, JENNIFER M (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6723 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8106
Mailing Address - Country:US
Mailing Address - Phone:225-926-2400
Mailing Address - Fax:225-926-2470
Practice Address - Street 1:1220 BERARD ST STE B
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4865
Practice Address - Country:US
Practice Address - Phone:337-332-6120
Practice Address - Fax:337-332-5537
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 05212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist